陕西省恶性浆膜腔积液诊治专家共识（2021版）

本共识所言浆膜腔是指心包腔、胸膜腔及腹膜腔，恶性浆膜腔积液是指浆膜腔积液中经脱落细胞学检查发现恶性细胞或浆膜组织活检病理诊断为恶性肿瘤，它是肿瘤转移的一种特殊表现形式，为晚期恶性肿瘤患者常见合并症之一，大量积液时可严重影响患者生活质量，甚至危及生命。我国与欧美国家之诊疗理念存在明显差异，目前全球尚缺乏明确的恶性浆膜腔积液诊疗指南或规范。我国现有2014年发表的《恶性胸腔积液诊断与治疗专家共识》，不包括恶性心包腔与腹膜腔积液，且部分治疗方法（如滑石粉胸膜固定术）在临床上并未广泛应用。本共识主要分为三大部分，一是介绍了目前全球恶性浆膜腔积液治疗现状，欧美国家治疗核心思想，我国治疗进展；二是详细介绍了该病诊断流程，包括病史询问、临床表现、影像学检查、肿瘤标志物检测，重点说明了脱落细胞学或浆膜组织活检病理检查方法，包括近年来兴起的细胞块石蜡包埋切片技术在分子基因检测方面的应用；三是该病治疗流程，包括局部治疗与系统治疗原则，对普通式抽液/引流联合药物灌注治疗方法的适应证、主要药物推荐、药物剂量、灌注时间、不良反应的预防与处理，以及特殊类型的恶性浆膜积液处理方法等进行了详细介绍，对系统治疗原则、全身给药选择亦给予了明确指导；最后简要说明了恶性胸、腹腔积液体外热循环灌注化疗技术的适应证与操作流程。目前，恶性浆膜腔积液诊治的中文期刊报道文献虽众多，但高质量文献极少，更谈不上证据级别，但本共识充分考虑到不同级别的医疗机构条件，具有广泛的普适性、较强的实用性及可操作性。

Expert consensus on diagnosis and treatment of malignant serous effusion in Shaanxi Province (2021 version)

The serous cavity mentioned in this consensus refers to the pericardial cavity, pleural cavity, and peritoneal cavity. Malignant serous effusion refers to the detection of malignant cells in the serous effusion through exfoliate cytology or the diagnosis of malignant tumor by serosal tissue biopsy. Malignant serous effusion is a special manifestation of tumor metastasis, and it is one of the common complications of patients with advanced malignant tumors. Large amounts of malignant serous effusion can affect the quality of life seriously and be even life-threatening. The treatment concepts for malignant serous effusion are obviously different between China and European and American. Currently, diagnosis and treatment guidelines or norms are insufficient worldwide. The existing expert consensus on the diagnosis and treatment of malignant serous effusion in China was published in 2014. It does not include pericardial effusion and ascites effusion, and some treatment strategies (such as talcum pleurodesis) are not widely used in clinical practice. This consensus mainly includes three parts. The first is to introduce the global treatment status and the main treatment concepts in European and American countries, as well as the progress of treatment in China. The second part gives a detailed introduction to the diagnosis process, including medical history, clinical manifestations, imaging examinations, and tumor marker detection. The focus is on the exfoliative cytology and serosal biopsy methods, including the application of paraffin-embedded section technology of cell blocks in molecular genetic testing that has emerged in recent years. The third part discusses the treatment process, including the principles of local and systemic treatment. In terms of local treatment, the indications, main drug recommendations, drug dosage, infusion time, prevention and treatment of adverse reactions, and treatment methods for special types of malignant effusion are introduced in detail for common fluid drainage or drainage combined with drug infusion therapy. In terms of systemic therapy, clear guidance is also given to the principles of systemic therapy and the choice of systemic drug delivery. In the last part, the indications and operating procedures of external thermo-circulation perfusion chemotherapy are explained briefly. At present, although there is a large amount of Chinese literature on the diagnosis and treatment of malignant serous effusions, the quality of the literature is not high, let alone the level of evidence. However, this consensus has fully considered the actual conditions of different levels of medical institutions, and has universal applicability, strong practicability, and maneuverability.