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目的介绍隧道式胸腔引流管(tunnelled pleural catheter,TPC)治疗恶性胸腔积液(MPE)的方法,探讨其临床应用价值。方法分析美国西南医学中心St.Paul医院自2002年10月至2005年11月共对112例MPE患者植入TPC的临床资料,其中男69例,女43例;年龄58.5±6.7岁。主要原发病为原发性肺癌、转移性肺肿瘤(原发癌为淋巴瘤、乳腺癌、卵巢癌)、胸膜间皮瘤;分析MPE患者TPC植入的效果。结果在3年观察期内,112例MPE患者共应用125例次TPC治疗,其中10例为对侧植入TPC,4例为同侧再次植入TPC。随访2周后有48例次症状完全缓解,62例次症状部分缓解,5例次症状未缓解,有5例次植管失败,5例次TPC植入术后2周内失去随访。120例次成功植入TPC患者中有51例发生继发性胸膜炎,仅5例在管道拔除后需要再次胸腔治疗。随访2周中单胸腔积液量<20%。导管留置时间平均为56 d。所有TPC植入术后患者随访期的生存时间平均为144 d,随访1个月和1年的病死率分别为12.8%和83.6%。结论对具有门诊治疗条件、需要姑息治疗的MPE患者,TPC是有效的方法之一。
Objective To introduce the method of tunneling pleural catheter (TPC) for the treatment of malignant pleural effusion (MPE) and to discuss its clinical value. Methods Clinical data of 112 patients with MPE implanted with TPC from St. Paul Hospital of the Southwestern Medical Center from October 2002 to November 2005 were analyzed. There were 69 males and 43 females, aged 58.5 ± 6.7 years. The main primary disease is primary lung cancer, metastatic lung cancer (primary cancer is lymphoma, breast cancer, ovarian cancer), pleural mesothelioma; analysis of MPE patients TPC implantation effect. Results During the 3-year observation period, 125 cases of TPC were treated in 112 patients with MPE. TPC was implanted in 10 cases and contralateral TPC in 4 cases. Forty-eight cases were completely relieved after 2 weeks of follow-up. The symptoms were partially relieved in 62 cases. The symptoms were not relieved in 5 cases. Five cases failed in the procedure. Five cases were lost follow-up within 2 weeks after TPC implantation. Of the 120 cases successfully implanted with TPC, 51 developed secondary pleuritis and only 5 required re-thoracotomy after removal of the duct. Follow-up 2 weeks in a single pleural effusion <20%. Catheter retention time averaging 56 d. The average survival time of all patients after TPC implantation was 144 days. The mortality rates at 1 month and 1 year follow-up were 12.8% and 83.6% respectively. Conclusion TPC is one of the effective methods for MPE patients who need outpatient treatment and need palliative treatment.