Die thorakoskopische videoassistierte Talkumpleurodese - eine effektive Behandlungsmethode des malignen Pleuraergusses

Zusammenfassung

Einleitung: Das palliative Therapieziel eines malignen Pleuraergusses sollte eine schnelle, effektive und schmerzlose Beseitigung des Ergusses sein.
Patienten und Methode: Seit 1995 wurden bei 46 Patienten retrospektiv die Ergebnisse von 51 videoassistierten thorakoskopischen Talkumpleurodesen (TTP) analysiert. Häufigste Genese der malignen Pleuraergüsse waren das Mammakarzinom, gefolgt von dem Bronchialkarzinom. Voraussetzung zur videoassistierten TTP war die Verifizierung des malignen Pleuraergusses mittels einer Zytologie.
Ergebnisse: An Komplikationen sahen wir eine Pneumonie und 2 Rezidive. Vier Patienten starben postoperativ aufgrund ihrer fortgeschrittenen Grunderkrankung. Die durchschnittliche Liegezeit betrug 8 (3-55) Tage.
Schlussfolgerung: Die videoassistierte TTP stellt zur palliativen Behandlung maligner Pleuraergüsse das therapeutische Verfahren der Wahl dar, da die Rezidivrate gering ist und das Verfahren wenig invasiv.

Abstract

Introduction: Aim of the palliative therapeutic procedure should be a fast, efficient and pain free treatment of the malignant pleural effusions.
Patients and method: Since 1995 the results of malignant pleural effusions treatment were analyzed retrospectively in 46 patients who underwent 51 video-assisted TTP. The most frequent origin of malignant pleural effusion was breast cancer, followed by bronchial carcinoma. Precondition for video-assisted TTP was the verification of a malignant pleural effusion by cytology.
Results: Following TTP one patient suffered from pneumonia, two recurrent diseases occurred. Four patients died due to their severe primary malignancy. Average hospitalization was 8 days (3-55).
Conclusion: Video-assisted TTP is the standard procedure in palliative treatment of malignant pleural effusion; the recurrence rate is low and the technique minimal invasive.

Schlüsselwörter

Maligner Pleuraerguss - Thorakoskopische Talkumpleurodese

Key words

Malignant pleural effusion - Thoracoscopic talcum pleurodesis

Literatur

• 1 Aelony Y. Talc pleurodesis. Talc slurry versus talc poudrage.  Chest. 1995;  108 289
• 2 Aelony Y. Cost-effective pleurodesis.  Chest. 1998;  113 1731-1732
• 3 Aelony Y, King R, Boutin C. Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions.  Ann Intern Med. 1991;  115 778-782
• 4 Boutin C, Viallat J R, Cargnino P, Farisse P. Thoracoscopy in malignant pleural effusions.  Am Rev Respir Dis. 1981;  124 588-592
• 5 Chernow B, Sahn S A. Carcinomatous involvement of the pleura: an analysis of 96 patients.  Am J Med. 1977;  63 695-702
• 6 Fentiman I S, Rubens R D, Hayward J L. The pattern of metastatic disease in patients with pleural effusions secondary to breast cancer.  Br J Surg. 1982;  69 193-194
• 7 Fentiman I S, Millis R, Sexton S, Hayward J L. Pleural effusion in breast cancer: a review of 105 cases.  Cancer. 1981;  47 2087-2092
• 8 Furrer M, Inderbitzi R. Pleurodesis technique in malignant pleural effusion.  Schweiz Med Wochenschr. 1982;  122 181-188
• 9 Glazer M, Berkman N, Lafair J S, Kramer M R. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion.  Chest. 2000;  117 1404-1409
• 10 Hartman D L, Gaither J M, Kesler K A, Mylet D M, Brown J W, Mathur P N. Comparison of insufflated talc under thoracoscopic guidance with standard tetracycline and bleomycin pleurodesis for control of malignant pleural effusions.  J Thorac Cardiovasc Surg. 1993;  105 743-747
• 11 Hausheer F H, Yarbro J W. Diagnosis and treatment of malignant pleural effusion.  Semin Oncol. 1985;  12 54-75
• 12 Inderbitzi R G, Grillet M P. Risk and hazards of video-thoracoscopic surgery: a collective review.  Eur J Cardiothorac Surg. 1996;  10 483-489
• 13 Keller S M. Current and future therapy for malignant pleural effusion.  Chest. 1993;  103 S63-S67
• 14 Kennedy L, Vaughan L M, Steed L L, Sahn S A. Sterilization of talc for pleurodesis. Available techniques, efficacy, and cost analysis.  Chest. 1995;  107 1032-1034
• 15 Light R W, Vargas F S. Pleural sclerosis for the treatment of pneumothorax and pleural effusion.  Lung. 1997;  175 213-223
• 16 Livingston R B, McCracken J D, Trauth C J, Chen T. Isolated pleural effusion in small cell lung carcinoma: favorable prognosis. A review of the Southwest Oncology Group experience.  Chest. 1982;  81 208-211
• 17 Maiche A G. Management of peritoneal effusions with intracavitary mitoxantrone or bleomycin.  Anticancer Drugs. 1994;  5 305-308
• 18 Marel M, Stastny B, Melinova L, Svandova E, Light R W. Diagnosis of pleural effusions. Experience with clinical studies, 1986 to 1990.  Chest. 1995;  107 1598-1603
• 19 Martini N, Bains M S, Beattie E J. Indications for pleurectomy in malignant effusion.  Cancer. 1975;  35 734-738
• 20 Milanez d C. Filho L O. de Campos W W. Sette H. Fernandez A. Filomeno L T. Jatene F B. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax [see comments].  Chest. 2000;  118 13-17
• 21 Noppen M, Degreve J, Mignolet M, Vincken W. A prospective, randomised study comparing the efficacy of talc slurry and bleomycin in the treatment of malignant pleural effusions.  Acta Clin Belg. 1997;  52 258-262
• 22 Rodriguez-Panadero F. Current trends in pleurodesis.  Curr Opin Pulm Med. 1997;  3 319-325
• 23 Sartori S, Trevisani L, Nielsen I, Tassinari D, Abbasciano V. Intracavitary bleomycin vs interferon in the management of malignant pleural effusions.  Chest. 1998;  113 1145-1146
• 24 Schafers S J, Dresler C M. Update on talc, bleomycin, and the tetracyclines in the treatment of malignant pleural effusions.  Pharmacotherapy. 1995;  15 228-235
• 25 Sorensen P G, Svendsen T L, Enk B. Treatment of malignant pleural effusion with drainage, with and without instillation of talc.  Eur J Respir Dis. 1984;  65 131-135
• 26 Tschopp J M, Bolliger C T, Boutin C. Treatment of spontaneous pneumothorax: why not simple talc pleurodesis by medical thoracoscopy?.  Respiration. 2000;  67 108-111
• 27 Viallat J R, Boutin C. Malignant pleural effusions: recourse to early use of talc.  Rev.Med.Interne. 1998;  19 811-818
• 28 Viallat J R, Rey F, Astoul P, Boutin C. Thoracoscopic talc poudrage pleurodesis for malignant effusions. A review of 360 cases.  Chest. 1996;  110 1387-1393
• 29 Viskum K, Lange P, Mortensen J. Long term sequelae after talc pleurodesis for spontaneous pneumothorax.  Pneumologie. 1989;  43 105-106
• 30 Walker-Renard P B, Vaughan L M, Sahn S A. Chemical pleurodesis for malignant pleural effusions.  Ann Intern Med. 1994;  120 56-64
• 31 Walter M, Türler A, Schmitz-Rixen T. Die Talkum-Pleurodese bei rezidivierendem malignen Pleuraerguss - eine prospektive Beobachtungsstudie.  Zentralbl Chir. 1996;  121 216-222
• 32 Weick J K, Kiely J M, Harrison E G. Carr D T. Scanlon P W. Pleural effusion in lymphoma.  Cancer. 1973;  31 848-853
• 33 Weissberg D, Ben Zeev I. Talc pleurodesis. Experience with 360 patients.  J Thorac Cardiovasc Surg. 1993;  106 689-695
• 34 Weissberg D, Kaufman M. The use of talc for pleurodesis in the treatment of resistant empyema.  Ann Thorac Surg. 1986;  41 143-145
• 35 Yim A P, Izzat M B. Thoracoscopic talc poudrage for malignant effusions: should it be the procedure of choice?.  Chest. 1997;  112 1148

Korrekturadresse
zurzeit - bis März 2003