滑石粉硬化材料在胸腔镜胸膜固定治疗顽固性恶性胸腔积液中的应用

背景：胸腔镜胸膜固定为恶性胸腔积液公认的积极有效治疗手段，硬化剂的优劣直接关系胸膜固定的成功与否，关系到术后的恢复。目的：探讨滑石粉法胸腔镜胸膜固定在顽固性恶性胸腔积液治疗中的作用。方法：纳入顽固性恶性胸腔积液患者29例，其中男14例，女15例，年龄38-79岁，在双腔气管插管静脉复合麻醉下行胸腔镜胸膜固定，硬化剂选择无菌滑石粉，术后观察不良反应情况，术后1个月检查胸部CT，观察胸水量。结果与结论：29例术后均出现胸痛，自行缓解18例，需口服曲马多治疗患者8例，需口服吗啡或注射杜冷丁或吗啡患者3例。术后3 d出现发热者3例。全组无肺水肿、急性呼吸窘迫综合征等严重并发症发生，无死亡病例。术后1个月，治疗有效24例，显效3例，无效2例，总有效率为93%。表明滑石粉法胸腔镜胸膜固定为治疗顽固性恶性胸腔积液一种积极有效的手段。

Utilization of talc pleurodesisvia thoracoscopy in the treatment of refractory malignant pleural effusion

BACKGROUND：Although thoracoscopy with pleurodesis is regarded as a positive and effective way for the treatment of malignant pleural effusion, the merit and demerit of sclerosants are directly related to postoperative recovery and the success of pleurodesis. OBJECTIVE：To evaluate the therapeutic effect of talc pleurodesisvia thoracoscopy in the treatment of refractory malignant pleural effusions METHODS：There were 14 male and 15 female patients in this study, age ranging from 38 to 79 years. Al patients with refractory malignant pleural effusion underwent talc pleurodesis under thoracoscopy. The postoperative adverse reactions, chest CT scan 1 month after operation and the fluid drainage were observed. RESULTS AND CONCLUSION：Twenty-nine patients with chest pain were observed in this study. Eighteen patients could relieve the pain itself without medications, eight patients required oral Tramadol and three patients took Demerol or morphine oraly to ease the pain. Fever occurred in three cases at 3 days after operation. Neither pneumonedema, acute respiratory failure, nor death ocurred postoperatively. One month later, complete successful pleurodesis was achieved in 24 cases, and partial successful in 3 cases, and unsuccessful in 2 cases. The results indicate that thoracoscopy with talc pleurodesis can be regarded as a positive and effective way for the treatment of malignant pleural effusion.