摘要
目前恶性胸腔积液管理仍是临床工作面临的巨大挑战。2018年11月,美国胸科协会、胸外科医师学会与胸部放射学学会基于最新临床研究证据,针对恶性胸腔积液管理中的7个临床问题,作出了相应临床意见推荐。本文对此进行解读,以期为规范恶性胸腔积液管理和未来相关研究提供参考依据。
The management of malignant pleural effusion remains a clinical challenge. In November 2018,American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
引文
1中国恶性胸腔积液诊断与治疗专家共识组.恶性胸腔积液诊断与治疗专家共识.中华内科杂志,2014, 53(3):252-256.
2 Psallidas I, Kalomenidis I, Porcel JM, et al. Malignant pleural effusion:from bench to bedside. Eur Respir Rev, 2016, 25(140):189-198.
3 Asciak R, Rahman NM. Malignant pleural effusion:from diagnostics to therapeutics. Clin Chest Med, 2018, 39(1):181-193.
4 Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of malignant pleural effusions. An official ATS/STS/STR clinical practice guideline. Am J Respir Crit Care Med, 2018, 198(7):839-849.
5 Grogan DR, Irwin RS, Channick R, et al. Complications associated with thoracentesis. A prospective, randomized study comparing three different methods. Arch Intern Med, 1990,150(4):873-877.
6 Gordon CE, Feller-Kopman D, Balk EM, et al. Pneumothorax following thoracentesis:a systematic review and meta-analysis.Arch Intern Med, 2010, 170(4):332-329.
7 Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest, 2013, 143(2):532-538.
8 Tremblay A, Robbins S, Berthiaume L, et al. Natural history of asymptomatic pleural effusions in lung cancer patients. J Bronchology, 2007,14(2):98-100.
9 Porcel JM, Gasol A, Bielsa S, et al. Clinical features and survival of lung cancer patients with pleural effusions. Respirology, 2015,20(4):654-659.
10 Huggins JT, Sahn SA, Heidecker J, et al. Characteristics of trapped lung:pleural fluid analysis, manometry, and air-contrast chest CT.Chest, 2007,131(1):206-213.
11 Roberts ME, Neville E, Berrisford RG, et al. Management of a malignant pleural effusion:British thoracic society pleural disease guideline 2010. Thorax, 2010, 65(Suppl 2):ii32-40.
12 Bhatnagar R, Corcoran JP, Maldonado, et al. Advanced medical interventions in pleural disease. Eur Respir Rev, 2016,25:199-213.
13 Feller-Kopman D. Therapeutic thoracentesis:the role of ultrasound and pleural manometry. Curr Opin Pulm Med, 2007, 13:312-318.
14 Lee HJ, Yarmus L, Kidd D, et al. Comparison of pleural pressure measuring instruments. Chest, 2014,146(4):1007-1012.
15 Lan RS, Lo SK, Chuang ML, et al. Elastance of the pleural space:a predictor for the outcome of pleurodesis in patients with malignant pleural effusion. Ann Intern Med, 1997, 126(10):768-774.
16 Scarci M, Caruana E, Bertolaccini L, et al. Current practices in the management of malignant pleural effusions:a survey among members of the European Society of Thoracic Surgeons. Interact Cardiovasc Thorac Surg, 2017, 24(3):414-417.
17 Dresler CM, Olak J, Herndon JE 2nd, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest, 2005,127(3):909-15.
18 Boshuizen RC, Vd Noort V, Burgers JA, et al. A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis(NVALT-14). Lung Cancer, 2017,108:9-14.
19 Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion:the TIME2randomized controlled trial. JAMA, 2012, 307(22):2383-2389.
20 Demmy TL, Gu L, Burkhalter JE, et al. Optimal management of malignant pleural effusions(results of CALGB 30102). J Natl Compr Canc Netw,2012,10(8):975-982.
21 Thomas R, Fysh ETH, Smith NA, et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion:The AMPLE Randomized Clinical Trial. JAMA, 2017, 318(19):1903-1912.
22 Iyer NP, Reddy CB, Wahidi MM, et al. Indwelling pleural catheter versus pleurodesis for malignant pleural effusions:a systematic review and meta-Analysis. Ann Am Thorac Soc, 2019, 16(1):124-131.
23 Bhatnagar R, Keenan EK, Morley AJ, et al. Outpatient talc administration by indwelling pleural catheter for malignant effusion. N Engl J Med, 2018, 378(14):1313-1322.
24 Clive AO, Jones HE, Bhatnagar R, et al. Interventions for the management of malignant pleural effusions:a network metaanalysis. Cochrane Database Syst Rev, 2016,(5):CD010529.
25 Yim AP, Chan AT, Lee TW, et al. Thoracoscopic talc insufflation versus talc slurry for symptomatic malignant pleural effusion. AnnThorac Surg, 1996, 62(6):1655-1658.
26 Mummadi S, Kumbam A, Hahn PY. Malignant pleural effusions and the role of talc poudrage and talc slurry:a systematic review and meta-analysis. F1000Res, 2014, 3:254.
27施焕中.理性与无奈的选择:美国2018版恶性胸腔积液管理指南解读.协和医学杂志,2018, 9(6):89-91.
28 Ohm C, Park D, Vogen M, et al. Use of an indwelling pleural catheter compared with thorascopic talc pleurodesis in the management of malignant pleural effusions. Am Surg, 2003, 69(3):198-202.
29 Thornton RH, Miller Z, Covey AM, et al. Tunneled pleural catheters for treatment of recurrent malignant pleural effusion following fai led pleurodesis. J Vasc Interv Radiol, 2010, 21(5):696-700.
30 Putnam JB Jr, Light RW, Rodriguez RM, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions.Cancer, 1999, 86(10):1992-1999.
31 Fysh ETH, Waterer GW, Kendall PA, et al. Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion. Chest, 2012,142(2):394-400.
32 Fysh ETH, Tremblay A, Feller-Kopman D, et al. Clinical outcomes of indwelling pleural catheter-related pleural infections:an international multicenter study. Chest, 2013, 144(5):1597-1602.
33 Mahmood K, Bower C. Treatment of infection associated with tunneled pleural catheters. J Bronchology Interv Pulmonol, 2010,17(1):69-72.
34 Nasreen N, Mohammed KA, Brown S, et al. Talc mediates angiostasis in malignant pleural effusions via endostatin induction.Eur Respir J, 2007, 29(4):761-769.