胸腔镜下胸膜固定术治疗恶性胸腔积液的疗效分析

目的探讨内科胸腔镜下滑石粉胸膜固定术治疗恶性胸腔积液的疗效。方法我科收治的48例中-大量恶性胸腔积液患者随机分为两组,实验组25例行内科胸腔镜下滑石粉胸膜固定术,对照组23例经常规胸腔闭式引流后于胸腔内灌注滑石粉。经胸膜固定后,对于PS 0-2分的患者均予全身化疗2周期。随访复查胸CT及B超,观察12周的胸水控制情况,并对两组的疗效及不良反应进行统计学分析。结果实验组有效率92.0%（23/25）、完全缓解率84.0%（21/25）,对照组有效率60.9%（14/23）、完全缓解率43.5%（10/23）,二者具有显著性差异。不良反应中,胸痛实验组高于对照组,差异有统计学意义;发热两组无统计学差异。结论内科胸腔镜下滑石粉胸膜固定术治疗恶性胸腔积液疗效好,且具有安全、微创特点,值得临床推广。

Efficacy analysis of medical thoracoscopic pleurodesis in the treatment of patients with malignant pleural effusion

Objective To discuss the effect of medical thoracoscopic talc pleurodesis in the treatment of patients with malignant pleural effusion. Methods 48 patients with large amount of malignant pleural effusion were randomly divided into two groups. The test group （n = 25 ） was treated with medical thoracoscopic talc pleurodesis, and the control group was treated with talc pleurodesis after rou- tine closed thoracic drainage. After the pleurodesis, the patients with PS 0 - ：2 grade were treated with ：2 periods of systemic chemotherapy. All patients were evaluated by chest CT and B-mode ultrasound 12 weeks after, and the curative effect and side effects were analyzed and compared between the two groups. Results The effective rates were 92. 0% （23/25） and 60. 9% （ 14/23 ）, and the complete remission rates were 84.0% （21/25） and 43.5% （ 10/23 ） respectively in the test group and in the control group with significant differences. The side effect of pectoralgia was severer in the test group than in the control group with significant difference. The fever in the two groups showed no statistical difference. Conclusion Medical thoracoscopic talc pleurodesis is an effective method in the treatment of malignant pleural effusion with safe and minimal invasive characteristics. Thus it is worth to be promoted widely in clinical practice.