| Objective: Malignant pleural effusion is caused by the pulmonary malignant tumor or other parts of the malignant tumor invasion pleura or pleural primary tumor. Nowadays, mainly symptomatic patients used the treatment of pleurodesis, through the way of chest tube or thoracoscope in order to eliminate effusion and pour into hardener and chemotherapeutic drugs. However, for the patients with the week of recruitment maneuver and without good fix of theirs pleura, adopting what methods to treat is awaiting to discuss.In recent years, there are a few foreign scholars began to used "the subcutaneous implantable pleural port " in the treatment of pleural effusion who came from France, Japan, Germany, Switzerland, Belgium, etc. and got lots of experience. This study is based on the perfusion treatment for the New Zealand white rabbit subcutaneous implantable pleural port surgery. Watching the different pleural and physical reactions of white rabbits that is in different surgery between this device implant and center vein implant. Further more, this study will get a further treatment effect and risk assessment in using this device of malignant pleural effusion.Method: Choosing 72 New Zealand male white rabbits in Hebei medical university who’s weight are 2 kg plus or minus 1 kg. The pleural ports used in this study are taken out from the patients in the Forth Hospital of Hebei Medical University that their structure and principal are the same as foreign experts used. Center vein pipe in this study is produced by ARROW Brand Company of America, which can be used after rinsing by physiological saline and sterilizing by ethylene oxide.The 72 rabbits are randomly divided into three groups, each group of 24 rabbits. In Group A, the rabbits’ chests take into implantable pleural port and perfuse physiological saline. In Group B the rabbits’ chests take into central venous tube and perfuse physiological saline. In Group C the rabbits’ chests take into implantable pleural port and perfuse cisplatin.After three months trial, extracting arterial blood from Group A white rabbits’ ear artery. While, assaying blood gas analysis and comparing different indexes with these before operation, all these are based upon rabbits which in this study are normal, such as the germs don’t invade organism, the tubes are not detachable, etc. so as to guarantee this study is efficient. This study adopts the principle of experimental animal ethics requirements to execute the experimental rabbits. After gradually anatomy, fetching the soft tissue circled by implantable pleural port, and getting parietal pleura, diaphragmatic muscle tissue and the lung tissue for take the pathological examination.Comparisons: 1 The comparison of Group A before and after test.By comparison, no obvious changes in blood gas test. It confirms that the implantable pleural port has less effect on lung function. From the rabbits’ chests CT examination, it shows that no occurrence of atelectasis, pneumonia. And the pathological test results of the ipsilateral lung tissue show that the alveolar structure is clear and mainly normal. It indicates this device implanted in the chest has no influence and no obvious stimulation to lung. 2 The comparison of Group A Group B. 2.1 Infection rateUntil the end of experiment, only one white rabbit has incision inflammation, and the other 23 rabbits without infection in Group A. While, in Group B 12 rabbits’ incision have inflammation, 2 rabbits’ incision get fester, 1 rabbit died by pyothorax which happened at 50 days after surgery, and other nine rabbits are uninfected. After Wilcoxon rank sum test, P < 0.001 shows that under the condition of infusing normal saline, application implantable pleural port and application center vein implant has statistically significant discrepancy is that application of the implantable pleural port infection was significantly lower than the center vein implant. 2.2 Comparison of unobstructedIn the whole experiment, Group A and B are unobstructed, which inject drug smoothly, without blocking the pipe. It abdicates that implantable pleural port chest port and center vein implant in this aspect has no obvious difference. 2.3 Comparison of stability of the implantThe implants of 24 white rabbits in Group A positioning stabile. In Group B, 1 rabbits’ implant is broken by scratching. It explains that the pleural port implant in subcutaneous are stable and not easy to shift or damaged. While, the pipe in center vein is with exposed part is easy to be lose or damaged by force, extrusion, sharp objects contacting. 3 Comparison of Group A and Group CPleural adhesions degree results in Group A, it shows that 21 rabbits do not have obvious pleural adhesions and lung tissue surface are normal. The other three have a belt of adhesion, located in the tube into the chest. In Group C, 24 rabbits have obvious adhesion, main adhesion near heart diaphragm angle and costophrenic angle. And one of them has three to five belt of adhesion. 21 have more than five adhesion tape. 2 rabbits whole chest have extensive adhesion. By comparing Group C and Group A, the adhesion degree of Group C is significantly greater than that in group A. It proves again in pleural perfusion chemotherapy, the cisplatin stimulates pleura can happen aseptic inflammation and adhesion effection. While, in the saline groups around the chest tube test, it has no obvious adhesion. It illustrates the adhesion is caused by chemotherapy drug, but not the implantable port of the pleura.Results:1 The infection rate of subcutaneous implantable pleural port as chest drainage device is lower than the center vein implant.2 Subcutaneous implantable pleural port itself does not produce pleural adhesion effect.3 Subcutaneous implantable pleural port had no obvious effect on pulmonary function and systemic inflammatory response.4 Subcutaneous implantable pleural port is reliability and minimally invasive.5 Subcutaneous implantable pleural port is efficiency which can be used for long-term drainage and drug delivery.6 Cisplatin for perfusion chemotherapy can produce adhesion effect. |
PDF Full Text Request