| Objective: Malignant pleural effusion(MPE), fluid accumulations secondary to pleural metastasis of lung cancer or pleural primarily tumour, or other malignancy, is a common complication in the advanced stage of malignant tumour. It is prevalent and vexing problem in patients with advanced malignant disease.Generally speaking, MPE means bad prognosis. MPE median survival following diagnosis ranges from 3 to 12 months. The average life span of MPE patients is about 6 months. After the diagnosis of MPE, proper therapy should be taken. Treatment options for MPE are determined by several factors: the primary tumour, symptoms and performance status of the patiet, the patiet's body of common state, response to systemic therapy, and lung re-expansion following pleural fluid evacuation, and so on.More satisfactory methods for controlling these effusions have been developed. But the methods are diverse and provide variable results. In some patients, it is no helpful to relieve the amount of pleural effussion with standard treatment. Despite recent advances in chemotherapy therapy, there are still many patients who are disabled by recurrent effusions. Thchniques have been developed to effect local control of pleural fluid accumulation and alleviate the associated respiratory distress.The method of implanting fine-gastric tube into the thoracic cavity guided by type C trocar is a new method to treat MPE. It is convenient using this fine-gastric to drain MPE and inject drug into the thoracic cavity. Bleomycin is a kind of antineoplastic agent, which can inhibit the synthesis of DNA. Intrapleural BLM has low toxicities, high local level, good tolerance in treatment of MPE. BLM is a mild sclerosing agent to treat MPE.The aim of this test is to evaluate the effect and safety of implanting fine-gastric tube into the thoracic cavity guided by type C trocar with bleomycin to treat malignant pleural effusion, in contrast to the methods of thoracentesis.Methods: 80 patients with MPE were studied from January 2007 to March 2009. Male 54 and female 26, ages from 34 to 74 years old and the average age was 61. The selecting stands: (1) all the patients were suffered with MPE, the patients or their family accept this test to treat MPE; (2) without serious functional disorder of heart,liver and renal function; (3) without the contraindications of thoracentesis. All of 80 cases with malignant pleural effusion were devided into two groups. 40 patients in control group had thoracentesis; 40 patients in treatment group were inserted fine-gastric tube into the thoracic cavity guided by type C trocar to treat malignant pleural effusion. When the two groups of pleural fluid have been drained clear, inject bleomycin 60mg and normal sodium 40ml into the thoracic cavity twice a week.Results: Four weeks later, we apply WHO standard to evaluate the effects of treating malignant pleural effusion. The overall responses rate for the treatment group and control group were 80%(32/40) and 55% (22/40), respectively. The difference of the effective rates was significant between two groups (p<0.05). The tubes were no obstruction, distortion, breakage and dislocation.The number of bleeding in treatment group was 2(>1ml), pneumothorax 2(p<0.05), pleura response 2(p<0.05), chest pain 3, fever 2, pulmonary edema 1(p<0.05), pleural thickening 8(≥0.3cm)(p<0.05), pleural fluid separated and parceled 6(p<0.05), mean time in hospital 15.00±4.88 days(p<0.05), but 3,9,8,3,3,8,18,15 csaes and 18.65±5.73 days in control group, respectively. The difference of the two groups was significant. The two groups were no infection. They are also no damage to livers and renals function.The adverse effects of thoracentesis were bleeding and pneumothorax, which were not too serious. By symptomatic treatment, they can be alleviated. The drainage tubes were no choked, distortion, breakage and defluxion. The main adverse effects of intrapleural BLM were chest pain and fever. The chest pain can be relieved to mix lidocaine into the injection, and it often need not to treat. Fever can be controlled by corresponding treatment. Chest pain and fever may last for 24h.Conclusions: The difference of the effective rates was significant between two groups(P<0.05). The mean hospital time in treatment group was shorter than control group(P<0.05). The adverse effects and complications in treatment group were also less than in control group(P<0.05).Above all, implanting fine-gastric tube into the thoracic cavity guided by type C trocar to treat malignant pleural effusion with intrapleural BLM is a ideal management to has a high success rate, low toxicities, good tolerance. It is easy, safy, cheap and little injury for patients. It is worthy to be advocated in clinic. |
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