Study Of The Different Therapeutic Methods And Effect Of Malignant Pleural Effusion

Malignant pleural effusion is a common complication of cancer found mostly in advanced lung cancer, breast cancer and lymphoma,which are about 75%, a few from ovarian cancer, stomach cancer, cervical cancer and sarcoma caused. The rapid growth of malignant pleural effusion, and continued existence can cause compression atelectasis and restrictive ventilatory dysfunction, and mediastinal shift to result in a serious impact on respiratory and circulatory functions. Therefore effective control of malignant pleural effusion, relieving symptoms and reducing the suffering of patients and improving the quality of life of patients, the extension of life is of great significance. Traditional repeated puncture and injection of anti-cancer drugs or pleural fixation is not effective because of incompletely pumping pleural effusion or parcels to the injected anti-cancer drug agent which can not be fixed or pleural uniform spread and be compressed on lungs which can not expand, and also cause iatrogenic pneumothorax, chest infection, empyema, and other serious complications. Thoracoscope with modern technology development, pleural fixation by thoracoscope achieves very good therapeutic success ,was classified as one of preferred methods of treatment in malignant pleural effusion. In thoracoscopic surgery, pleural effusion cleared away completely, isolated parcels and adhesion removed from pleural surface fiber membrane, quickly the lung expanded and the heart of oppression released, the patients with clinical symptoms apparently ease immediately. Therefore, no pleural effusion repeatedly taken to reduce the suffering of many patients, and greatly enhance the quality of life of patients. This paper reviews 128 patients with malignant pleural effusion treated from 2003 to 2008 in the hospital, as well as different methods and effect in the treatment were analyzed for malignant pleural effusion that the clinical diagnosis and treatment provide some help. Analysis of the report are as followsObjective: To study the different therapeutic methods and effect of malignant pleural effusion.Methods: 128 clinical data of malignant pleural effusion were analyzed retrospectively from 2003 to 2008,which was divided in two groups: thoracoscope and the thoracentesis or thoracic close drainage. the group of thoracoscope involves 58 cases,including 34 males, 24 female and age between 19 and 82 years old (mean age 59.1years old). the group of the thoracentesis or thoracic close drainage involves 70 cases,including 40 males, 30 female and age between 32 and 84 years old (mean age 60.0 years old).The methods of diagnosis and therapy: The diagnosis of all cases depends on cast-off cell from pleural fluid. For those cases which are not diagnosed by shedding cells in pleural fluid not less than three times, the biopsy of pleura will be done to diagnose them by thoracoscope.Thoracoscopic groups: patients are on the contralateral lying, with satisfactory intubation of double-lumen tube, general anesthesia, and in the contralateral lung ventilation. In the middle section seventh axillary intercostal incision, skin ,subcutaneous tissue, blunt muscle to the pleura are cutted open at approximately 1.5 cm, thoracoscope inserted, pleural effusion is suctioned cleanly. then observe thoracic situation by thoracoscope.skin at approximately 1.5 cm is cutted open in the seventh intercostals and posterior axillary line and the fourth intercostal and anterior axillary line. adhesion is separated andcutted with the cable-burning electricity knife. observe thoracic situation and cut pleural metastasis or nodules with biopsy forceps for three tissue biopsy, stop bleeding with electricity knife. Anaesthetists ventilate, if the lung can rehabilitate,pleural fixation will be in prograss. Rough gauze pad is with pleural wear until the pleura is on congestive or bloody exudate, talc powder is sprinkled uniformly by the peritoneal washes through 30 cm long rubber tubing with a few side holes by the end of its casing into the chest cavity, and tube drainage is keeping in the middle section seventh axillary intercostal line at the chest after the lungs is ventilated. Then closed suction drainage sustained until draining liquid<100mL/d. The thoracentesis or thoracic close drainage were used to treated malignant pleural fluid. After the pleural fluid was almost absorbed, therapeutic medicine were injected into thoracic cavity. The duct of thoracic close drainage was pulled out when the pleural fluid of drainage was less than 100ml/d. All the cases were followed up for four weeks. Results: The group of thoracoscope: 57 cases were healed well with an effective rate of 98.28% in this group,in which there were 40 cases completely released and 17 cases partly released. The only one failed because that pleural adhesions was too severe to separate and inflate the lung. There were 22 cases who were low-grade fever, 38 cases who were in light thoracalgia and 9 cases who had the symptom of sicchasia and vomiting in the side-effect of this treatment.those cases improved in health after symptomatic treatment. The thoracentesis or thoracic close drainage: 55 cases were healed well with an effective rate of 78.57% in this group,in which there were 33 cases complete released and 22 cases partly released. There was no significant difference on the factor of sex,age and side reaction (P>0.05), but there was significant difference in the treatment (P<0.05), and the group of thoracoscope is more effective than the another one.The group of thoracentesis or thoracic close drainage involve three groups, which consist of Bleomycin, Cisplatin and IL-2.20 cases were healed well with an effective rate of 89.96% in 23 cases into whose thoracic cavity Bleomycin was injected,in which there were 13 cases completely released and 7 cases partly released. 21 cases were healed well with an effective rate of 80.77% in 26 cases into whose thoracic cavity Cisplatin was injected,in which there were 11 cases completely released and 10 cases partly released.14 cases were healed well with an effective rate of 66.67% in 21 cases into whose thoracic cavity IL-2 was injected, in which there were 9 cases completely released and 5 cases partly released. There were 17 cases who were low-grade fever, 34 cases who were in light thoracalgia ,14cases who had the symptom of sicchasia and vomiting, 3 case leucopenia happened in and 3 case who had dysfunction of liver and kidney in the side-effect of this treatment.those cases improved in health after symptomatic treatment. All of them have no severe complications after surgery such as pneumothorax,ARDS etc. There was no significant difference in the three groups on the factor of sex ,age,treatment and side reaction (P>0.05).Conclusion: Thoracoscopic surgery to treat malignant pleural effusion is better than closed thoracic drainage.It is minimally invasive, painful light, the effective advantages not only can be used in the diagnosis of pleural effusion, but also the treatment of malignant pleural effusion. Thoracoscopic surgery can be integrated diagnosis and treatment, with more incomparable superiority than other methods. Along with the further development of minimally invasive technique, Thoracoscopic surgery will become one of the most commonly effective treatments of malignant pleural effusion, it is for clinical use.