Diagnosis And Treatment Of Malignant Pleural Effusion

Objective: to study the characteristics of clinical diagnosis andtreatment of malignant pleural effusion. Methods: 114 cases clinical data of malignant pleural effusionwere analyzed retrospectively from 2000 to 2006. Clinic data: the whole group involves 114 cases , including 74males , 40 femal (Male:female proportion =1.85:1).Age 34—84years old(mean age 62.64) . There were 71 patients who had massivepleural effussion (>1000ml ) , 35 ones who had medium pleuraleffussion (500-1000 ml ) , and 8 ones who had manipulus pleuraleffusion (<500ml ). There were 68 patients who was both sides ofpleural effusions . There were 46 patients who was half side ofpleural effusions .The method of diagnosis and therapy: The diagnosis of allcases depends on cast-off cell from pleural fluid and biopsy of pleura.Central venous catheter and thoracentesis were used to treatedmalignant pleural fluid. After the pleural fluid was almost absorbed ,parts of them were treated by injecting chemical pleurodesis intothoracic cavity.Results: 110 cases were diagnosed through the examination ofshedding cells in pleural fluid, 38 cases through one times and 72cases through many times.4 cases were diagnosed throughthoracoscopy.66 Patients were treated with central venous catheter.All of them have not complications after surgery.48 Patients weredrainaged through thoracentesis. 35 case of them need drainagingmany times, 5 cases suffered from pneumothorax after Biops, 1 casesfrom reexpansion pulmonary edemam, and 3 cases frompleurogenous response. chemical pleurodesis is an effective methodto treat malignant pleural effusion. After the pleural fluid was almostabsorbed, 76 cases were theated by this method.46 cases were theatedby injecting highly agglutinated staphylococcin into thoracic cavitywith an effective rate of 85.37%. 15 cases were theated by injectingcorynebacterium parvum into thoracic cavity with an effective rate of61.54%. 10 cases were theated by injectingcis-diamminedichloroplatinum into thoracic cavity with an effectiverate of 50%. 5 cases were theated by injecting talcum powder intothoracic cavity with an effective rate of 100%. highly agglutinatedstaphylococcin and corynebacterium parvum are two biologicresponse modifiers. The side-effect of their treatment is the most lest,mainly including low-grade fever and light thoracalgia,et al, andthe latter may induce the light injury of hepatic and renal function.Cisplatin is cytotoxic anticancer drugs,whose side-effect is the morelarger, including high -grade fever and reaction of gastrointestinaltract,et al,even little degree reduction of white blood cell. talcumpowder is the most effective sclerosing agent to treat malignantpleural effusion now,though high -grade fever and severe thoracalgiaincrease patient's suffering.Conclusion:1. the examination of shedding cells in pleural fluidis easier and more feasible, and the clinical diagnosis rate is raised byexaming many times.2.For those cases which are not diagnosed by shedding cells inpleural fluid, we think them diagnosed by thoracoscopy.3.Comparing central venous catheter with thoracentesis, theformer's therapeutic effect is more better, so this ways should beapplied extensively on the clinical treatment of malignant pleuraleffusion.4.injecting highly agglutinated staphylococcin into thoraciccavity has a higher effective rate and less side effect, so this medicinecan be the first selective medicine.