Abstract：
OBJECTIVE: Malignant pleural effusions (MPE) are a frequent and major turning point in neoplastic disease usually leading to poor life expectancy. Improve quality of life and relieve the dyspnea are the main objectives in this palliative care setting. This can be achieved by the placement of an indwelling catheter (IPC) or talc pleurodesis ideally performed by thoracoscopy route (talc poudrage). Beside to misidentify a trapped-lung, the latter requires a prolonged hospital stay and the IPC placement does not allow a high pleurodesis rate. To overcome these drawbacks, a combination of both technique could be proposed for the management of recurrent malignant pleural effusions. Safety and efficacy of this pragmatic approach are reported.
METHODS: Consecutive patients who have been managed for recurrent MPE by a combination of talc poudrage for pleural symphysis by thoracoscopy route ending with the insertion of IPC using the same thoracic point of entry. Demographic data, hospital length of stay (LOS), procedural-related complications, patients\' quality of life (QoL) and success of pleurodesis were collected. Patients were followed-up for 6 months.
RESULTS: The data of twenty-five consecutive patients undergoing the procedure were analyzed. Successful pleurodesis was obtained for 14/25 patients (66 %) at one month, 17/20 patients (85 %) at 3 months and 13/15 patients (86 %) at 6 months respectively. On average, the hospital LOS after the procedure was 3.24 days (IQR 1-4) with a median of 1 day. A prolonged hospitalization (>1 day) was never due to the procedure except for one patient (pneumothorax). No IPC related infection or procedure related deaths were noted.
CONCLUSIONS: Among patients with recurrent MPE, the combination of talc poudrage symphysis by thoracoscopy route and IPC placement on the same time results in a shortened hospital LOS and higher rate of pleurodesis. Further randomized clinical trials are needed to confirm these results.
METHODS: Consecutive patients who have been managed for recurrent MPE by a combination of talc poudrage for pleural symphysis by thoracoscopy route ending with the insertion of IPC using the same thoracic point of entry. Demographic data, hospital length of stay (LOS), procedural-related complications, patients\' quality of life (QoL) and success of pleurodesis were collected. Patients were followed-up for 6 months.
RESULTS: The data of twenty-five consecutive patients undergoing the procedure were analyzed. Successful pleurodesis was obtained for 14/25 patients (66 %) at one month, 17/20 patients (85 %) at 3 months and 13/15 patients (86 %) at 6 months respectively. On average, the hospital LOS after the procedure was 3.24 days (IQR 1-4) with a median of 1 day. A prolonged hospitalization (>1 day) was never due to the procedure except for one patient (pneumothorax). No IPC related infection or procedure related deaths were noted.
CONCLUSIONS: Among patients with recurrent MPE, the combination of talc poudrage symphysis by thoracoscopy route and IPC placement on the same time results in a shortened hospital LOS and higher rate of pleurodesis. Further randomized clinical trials are needed to confirm these results.
摘要：
目的：恶性胸腔积液（MPE）是肿瘤性疾病中常见的主要转折点，通常会导致预期寿命延长。改善生活质量和缓解呼吸困难是这种姑息治疗的主要目标。这可以通过放置留置导管（IPC）或滑石粉胸膜固定术来实现，理想情况下是通过胸腔镜检查（滑石粉袋）进行。除了错误识别被困的肺，后者需要延长住院时间,而IPC放置不允许较高的胸膜固定术率.为了克服这些缺点，这两种技术的结合可用于治疗复发性恶性胸腔积液。报告了这种务实方法的安全性和有效性。
方法：连续接受MPE治疗的患者，通过胸腔镜检查路径对胸膜联合进行滑石粉袋治疗，最后使用相同的胸廓入口点插入IPC。人口统计数据,住院时间（LOS），手术相关并发症,收集患者的生活质量（QoL）和胸膜固定术的成功率。随访6个月。
结果：分析了连续25例患者的数据。1个月后14/25例患者（66%）成功胸膜固定术，3个月时分别为17/20例（85%）和6个月时分别为13/15例（86%）。平均而言,术后医院LOS为3.24天(IQR1-4),中位数为1天.除了一名患者（气胸）外，该手术从未导致住院时间延长（>1天）。未发现IPC相关感染或手术相关死亡。
结论：在复发性MPE患者中，通过胸腔镜路径和IPC同时放置的滑石粉袋联合联合导致医院LOS缩短和胸膜固定率提高。需要进一步的随机临床试验来证实这些结果。
方法：连续接受MPE治疗的患者，通过胸腔镜检查路径对胸膜联合进行滑石粉袋治疗，最后使用相同的胸廓入口点插入IPC。人口统计数据,住院时间（LOS），手术相关并发症,收集患者的生活质量（QoL）和胸膜固定术的成功率。随访6个月。
结果：分析了连续25例患者的数据。1个月后14/25例患者（66%）成功胸膜固定术，3个月时分别为17/20例（85%）和6个月时分别为13/15例（86%）。平均而言,术后医院LOS为3.24天(IQR1-4),中位数为1天.除了一名患者（气胸）外，该手术从未导致住院时间延长（>1天）。未发现IPC相关感染或手术相关死亡。
结论：在复发性MPE患者中，通过胸腔镜路径和IPC同时放置的滑石粉袋联合联合导致医院LOS缩短和胸膜固定率提高。需要进一步的随机临床试验来证实这些结果。
