碘伏胸膜固定术与胸腔镜滑石粉胸膜固定术治疗恶性胸腔积液的对比研究

目的:对乳腺癌胸腔转移的恶性胸腔积液的患者,通过使用胸腔镜滑石粉喷洒和通过胸导管注入聚合碘行胸膜固定术,比较两种方法的有效性、安全性及成功率。方法:42个乳腺癌胸腔转移的恶性胸腔积液的患者纳入了此项前瞻性随机对照研究。所有患者都有中度至重度呼吸困难(MRC呼吸困难量表Ⅲ-Ⅴ级)。22个患者完成胸腔镜滑石粉胸膜固定术(A组),而20例(B组)在床旁完成胸腔注入聚合碘。比较两组患者胸膜固定的成功率,呼吸困难缓解情况,住院时间以及胸痛、发热等并发症发生情况。结果:胸膜固定术成功率两组无明显差异(91%vs 85%,P=0.9),术后并发症两组均较低。手术后,因胸膜炎性胸痛需要止痛处理的A组明显高于B组(18%vs 0,P=0.2)。手术后48小时内,A组患者中有4个病人(18%),B组中1个患者(5%)出现发热(38℃)。治疗后两组呼吸困难症状得到了较好的控制,呼吸困难程度为(Ⅰ-Ⅱ),但两组之间无统计学差异(P0.05)。没有患者在医院内死亡。术后B组患者的住院时间更短(P=0.009)。平均症状无进展时间隔为6.6(范围3-15)月。随访中胸腔积液复发需要从新干预的A组有2例,B组3例。结论:对于乳腺癌转移性胸腔积液,聚合碘可作为胸腔镜滑石粉胸膜固定术外不错的选择。聚合碘容易获得,便宜且安全,可通过胸腔引流管给药,如果必要可以重复操作。     

应用电视胸腔镜诊治病因不明胸腔积液的疗效观察

目的:探讨电视胸腔镜(video-assisted thoracoscopic surgery VATS)在诊治病因不明胸腔积液中的应用价值.方法:回顾分析2005年4月～2011年4月196例病因不明胸腔积液经电视胸腔镜手术的临床资料.均应用电视胸腔镜进行探查,根据病变情况选择切口部位.排净胸腔积液后,分离粘连,进行胸膜活检后恶性患者行胸膜固定术.结果:196例均明确诊断:140例恶性胸腔积液,36例结核胸腔积液,20例炎性胸腔积液.胸腔镜手术178例,胸腔镜辅助胸壁小切口手术18例.手术时间30～75min,平均54 min.出血量10～120mL,平均53 mL.10例出现术后肺漏气,胸腔引流量＜50 mL/24h拔除胸腔引流管,胸管留置时间4～19天,平均9.4天.191例成功控制胸腔积液,全组无院内死亡.22例接受化疗的恶性胸腔积液患者,随访14～34个月,平均23个月,复查胸片显示无胸腔积液、积气.结论:电视胸腔镜安全、有效、微创,便于操作,可作为诊治病因不明胸腔积液的主要方法.     

碘伏法电视胸腔镜治疗原发性自发性气胸98例的临床研究

目的:探讨碘伏法电视胸腔镜治疗原发性自发性气胸的安全性及临床疗效。方法:回顾性研究2010年1月-2013年1月唐都医院胸腔外科收治的98例原发性自发性气胸患者,按照是否行胸膜固定术随机分为两组,比较两组患者的手术时间、术中出血、术后引流量、住院时间、术后并发症发病率及术后1年气胸的复发率。结果:两组患者的手术时间、术中出血、术后漏气时间、住院时间及术后并发症(广泛皮疹、低血压、伤口感染)的发生率比较差异均无统计意义(P0.05),术中行胸膜固定术可显著降低术后气胸的复发率(P0.01)。结论:电视胸腔镜手术过程中利用碘伏涂擦壁层胸膜行胸膜固定术是一种能够有效预防原发性自发性气胸术后气胸复发的安全可靠的治疗方式。     

恶性胸腔积液综合治疗进展

恶性胸腔积液是恶性肿瘤累及胸膜,或是发生胸膜转移所致。它是癌症晚期常见的并发症,治疗难度大,预后较差。约有一半以上的癌症患者晚期出现胸腔积液。大量胸腔积液可引起胸痛,咳嗽,呼吸困难等,影响病人生存质量,治疗不及时可危及生命。因此我们治疗恶性胸腔积液的主要目的是缓解症状,有效的清除胸腔积液并防止它的再次蓄积,改善患者的生存质量,延长生存时间。目前,恶性胸腔积液治疗的方法较多,但是没有标准的治疗方法,总体疗效有限。由于其预后不佳,临床上多以姑息治疗手段为主。常见的方法有胸腔穿刺术,胸腔置管引流术,化学胸膜固定术,及胸膜剥除术等。生物免疫制剂协同其他方法治疗恶性胸腔积液被广泛应用于临床,疗效满意,毒副反应小。本文综合性的回顾恶性胸腔积液的治疗方法,就恶性胸腔积液的治疗进展进行简要分析。     

胸腔镜肺楔形切除术与胸腔镜肺叶切除加纵隔淋巴结清扫术治疗早期非小细胞肺癌患者的临床效果比较

目的:对比分析胸腔镜肺楔形切除术与胸腔镜肺叶切除加纵隔淋巴结清扫术治疗早期非小细胞肺癌患者的临床效果。方法:选择2012年1月～2016年12月我院心胸外科收治的70例早期非小细胞肺癌患者,将其随机分为两组。对照组采取胸腔镜肺叶切除加纵隔淋巴结清扫术治疗,观察组采取胸腔镜肺楔形切除术治疗。比较两组的手术情况、术后情况、预后情况以及生存情况。结果:观察组的术中出血量以及手术时间明显短于对照组(P0.05),术后总引流量、留置引流管时间、术后住院时间以及VAS疼痛评分均明显低于对照组(P0.05)。观察组术后1年的手术切缘转移率为0.00%(0/35),死亡率为11.43%(4/35),均明显低于对照组(P0.05)。两组的局部复发率、复发率、胸腔内转移率、淋巴结转移率、远处转移率、肿瘤相关性死亡率相比无明显的差异(P0.05)。对照组患者的无病进展生存期为8.24个月(95%CI:9.34～6.27),中位生存期为15.29个月(95%CI:12.14～21.78);观察组患者的无疾病进展生存期为11.26个月(95%CI:9.37～14.35),中位生存期为18.13个月(95%CI:15.24～22.36),均明显长于对照组(P0.05)。结论:胸腔镜肺楔形切除术治疗早期非小细胞肺癌患者的临床效果明显优于胸腔镜肺叶切除加纵隔淋巴结清扫术治疗。     

同期双侧胸腔镜联合肋骨接骨板内固定治疗双侧多发肋骨骨折的体会

目的:探讨同期双侧胸腔镜联合肋骨接骨板内固定治疗双侧多发肋骨骨折的方法及临床疗效评价。方法:对13例双侧多发肋骨骨折患者施行同期双侧胸腔镜联合肋骨接骨板内固定治疗,对于合并胸内损伤有胸腔探查指征者,先手术治疗损伤重的一侧;对于肋骨固定为主者,先手术治疗损伤较轻的一侧。固定材料选用形状记忆环抱接骨板。结果:全组13例患者均临床治愈,术后双侧胸痛明显缓解,胸廓畸形纠正,缩短ICU治疗时间,无明显并发症发生。结论:双侧多发肋骨骨折行同期双侧胸腔镜联合肋骨接骨板内固定治疗,能有效恢复胸廓的完整性,减少并发症,改善预后,而且具有创伤小的优点。     

三种检测方法对结核、恶性胸腔积液的鉴别价值

为了研究内科胸腔镜术、外周血及胸腔积液T-SPOT.TB、血清和胸腔积液IL-6(interleukin-6,IL-6)水平检测对于鉴别结核性和恶性胸腔积液的价值。我们纳入经内科胸腔镜确诊的结核性胸腔积液(tuberculous pleural effusion,TPE)患者49例、恶性胸腔积液(malignant pleural effusion,MPE)患者37例,入选患者均完善外周血及胸腔积液T-SPOT.TB和IL-6水平检测,对检测结果进行统计分析。(1)内科胸腔镜镜下显示:TPE患者主要表现为大小不等的粟粒样结节,常伴胸膜粘连、充血、水肿;MPE患者主要表现为大小不等的结节样改变,常伴胸膜凹凸不平、触之易出血。(2)胸腔积液T-SPOT.TB与IL-6水平检测的诊断效能高于外周血T-SPOT.TB和血清IL-6检测。其曲线下面积分别为0.910、0.875,胸腔积液T-SPOT的SFC数的最佳临界值为217/2.5×105/L,胸腔积液IL-6检测的最佳临界值为226 pg/m L。(3)胸腔积液T-SPOT.TB和IL-6检测的灵敏度、特异度、准确率分别为0.857、0.811、0.837,0.857、0.784、0.826,高于外周血T-SPOT.TB和血清IL-6检测。由结果可知,(1)内科胸腔镜具有直观、切口小、并发症少等优点,应用价值高。(2)胸腔积液T-SPOT.TB和IL-6水平测定可以用于辅助鉴别结核性和恶性胸腔积液,外周血T-SPOT.TB和IL-6水平对鉴别结核性、恶性胸腔积液的意义相对较小。     

老年患者在传统开胸与胸腔镜下手术切除周围型肺癌疗效的比较研究

目的:对比分析传统开胸手术和胸腔镜下肺叶切除对老年性早期周围型肺癌的疗效及生存曲线的差异。方法:选取我院行肺癌手术治疗的患者65例,均为周围型肺癌。采用非随机对照方法,将患者随机分为传统开胸手术组和胸腔镜组,其中开胸手术组34例,胸腔镜组31例。按照既定分组方案实施手术,对比分析两组患者一般属性资料、手术相关指标;术后随访至2016年6月,采用Kaplan-Meier法对比2组患者5年总生存率(OS)、无复发生存率(RFS)。结果:胸腔镜手术组手术时间明显长于开胸组(p0.05)。胸腔镜组拔出胸腔引流管天数明显缩短(p0.05)。胸腔镜组术中出血量少于开胸组(p0.05)。胸腔镜组术后并发症发生率、VAS评分、住院时间低于开胸组(p0.05)。但胸腔镜组住院总费用多于开胸组(p0.05)。开胸组组5年RFS为65.27%,胸腔镜组67.13%,差异无统计学意义(p0.05)。开胸组患者5年OS为53.73%,胸腔镜组为55.34%,差异有统计学意义(p0.05)。结论:相比传统开胸手术,胸腔镜下早期肺癌切除术出血量少,恢复快,术后并发症发生率低,术后5年总生存率高于传统开胸术。     

单孔胸腔镜肺癌根治术后使用单根胸腔引流管联合负压引流管的效果观察

目的:探讨单孔胸腔镜肺癌根治术后使用单根胸腔引流管联合负压引流管的效果。方法:选取2018年1月~2020年1月于我院行单孔胸腔镜肺癌根治术的肺癌患者100例为研究对象,采用随机数字表法分为两组,对照组患者放置一根30#多孔胸管,观察组在对照组的基础上放置一根负压引流管。比较两组患者的围术期相关指标、并发症的发生情况、手术VAS评分及CRP及PCT水平的变化情况。结果:两组患者总引流管留置时间和胸腔总引流量相比无统计学差异(P>0.05)。观察组患者的30#多孔胸管留置时间、住院时间及再次胸腔穿刺率显著短于/低于对照组(P<0.05),肺不张、漏气、积液或积气等总并发症发生率显著低于对照组(P<0.05);术后3 d和术后5 d的VAS评分均显著低于对照组(P<0.05),术后3 d的CRP及PCT水平显著低于对照组(P>0.05)。结论:单孔胸腔镜肺癌根治术后使用单根胸腔引流管联合负压引流管可显著减轻患者的疼痛,缩短30#多孔胸管留置时间及住院时间,降低再次胸腔穿刺率及并发症发生率,同时可缓解患者的炎症状态。     

胸膜腔黏连对非小细胞肺癌患者行胸腔镜下肺叶切除术的影响分析

目的:分析胸膜腔黏连对非小细胞肺癌患者行胸腔镜下肺叶切除术的影响,探讨患者行胸腔镜下肺叶切除术术后发生并发症的影响因素。方法:收集2014年1月到2017年12月份在我科行胸腔镜下肺叶切除的非小细胞肺癌患者,通过检索电子病历和电话随访的方式收集患者的基本资料,包括性别、年龄、BMI指数、是否吸烟、一秒用气呼气容积百分比(Percentage predicted forced expiratory volume in 1 s, FEV1%)、美国麻醉医师协会评分(American Society of Anesthesiologists,ASA)、术后病理结果和术前合发症等资料。收集患者手术相关情况,包括胸膜是否黏连、手术时间、术中出血、术中中转开胸、术后引流、住院时间、并发症和术后30天死亡,根据患者是否有胸膜黏连将其分为两组,对比分析两组基本情况和术后情况,观察胸膜黏连对术中及术后的影响。根据术后是否发生并发症将患者分为两组,对比分析两组的指标,并对有差异的指标进行Logistic回归分析,探讨胸膜黏连是否为术后并发症的独立危险因素和其他危险因素。结果:根据纳入排除标准,共有447例患者纳入研究,其中有142例患者术中发现胸膜黏连,胸膜黏连的患者手术时间、术中出血、中转开胸、术后前两天引流量、引流时间、术后住院时间和术后并发症发生率均高于胸膜没有黏连的患者(P0.05)。术后发生并发症的患者年龄、女性比例、吸烟人数、术前呼吸并发症、胸膜黏连、ASA评分和手术时间均高于术后未发生并发症的患者(P0.05)。胸膜黏连(OR=4.185, P=0.020)、ASA评分(OR=1.143, P=0.001)、吸烟(OR=3.329, P=0.005)、手术时间延长(OR=1.623, P=0.038)和术前呼吸合并症(OR=2.713, P=0.027)均是术后发生并发症的独立危险因素。结论:胸膜黏连增加了非小细胞肺癌患者行胸腔镜下肺叶切除术的手术难度、术中中转开胸和术后并发症发生的风险。     

Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis

Background

Talc pleurodesis has been widely used to control malignant pleural effusion; however, it is still not clear whether talc pleurodesis is more effective than other local therapies. We performed a meta-analysis to evaluate the efficacy and safety of talc pleurodesis in the management of malignant pleural effusion.

Methods

PubMed, Embase, and Web of Science were searched for English-language studies of clinical controlled trials comparing talc pleurodesis with control therapies until August 8, 2013. Success rate and incidence of adverse events were evaluated. Relative risks were estimated using random- or fixed- effects model and statistical heterogeneity was assessed using I² test.

Results

Twenty trials involving 1,525 patients with malignant pleural effusion were included. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.01–1.45; p = 0.035) with similar adverse events. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry (relative risk, 1.12; 95% confidence interval, 1.01–1.23; p = 0.026).

Conclusions

The current evidences suggested the benefit for talc pleurodesis in the treatment of malignant pleural effusion. Talc pleurodesis, especially thoracoscopic talc poudrage pleurodesis, should be performed in patients with malignant pleural effusion, especially those with life-expectancy longer than one month.     

Results of chemical pleurodesis with mitoxantrone in malignant pleural effusion from breast cancer

Background

Carcinoma of the breast is the second leading cause of malignant pleural effusions. This study reports on the efficacy of mitoxantrone as a sclerosing agent in patients with breast cancer who had a pleural effusion as a direct consequence of metastatic disease.

Patients and methods

Over a 5-year period, 114 patients with a known breast malignancy and having recurrent symptomatic pleural effusion referred for chest tube drainage and sclerotherapy were considered eligible. They had received no prior intrapleural therapy and had a predicted survival of >1 month. All of them underwent pleural drainage and chemical pleurodesis with mitoxantrone. Survival, complications and response to pleurodesis according to clinical and radiographic criteria were recorded. The data are expressed as the mean ± standard error of the mean (SEM) and the median. The χ² test was used for statistical analysis. To assess the prognostic value of Karnofsky's performance status score a Cox proportional hazards model was used.

Results

The mean age of the patients was 53.5 ± 2.1 years. Effusion occurred after 38.2 ± 6.2 months (range: 1–229 months) after the diagnosis. Ipsilateral effusion was seen in 73%, contralateral in 20% and bilateral in 7%. Forty patients (35%) had pleural effusion as the first evidence of recurrence. The mean volume of effusion drained was 1020 ± 125 ml and the chest tube was removed within 5 days in 82% of patients. Side effects of chemical pleurodesis included mainly fever, chest pain, nausea and vomiting. At 30 days 64 patients (56.3%) had a complete response (CR) and 30 patients (26.3%) partial response (PR) to pleurodesis (overall response: 82.6%). At 60 days the overall response was 78.5% (CR:53.5%, PR: 25%). The mean survival was 15.6 ± 2 months. Karnofsky's performance status score was found to be a statistically significant predictor. Patients with Karnofsky's performance status score >70 had a median survival of 513 days, as opposed to a median survival of only 63 days for patients with a Karnofsky's performance status score <30.

Conclusions

Mitoxantrone is effective in the treatment of malignant pleural effusion due to breast carcinoma with relatively low local or systemic toxicity. Karnofsky's performance status score at the time of pleurodesis is predictive of survival.

     

The Effect of Pleural Abrasion on the Treatment of Primary Spontaneous Pneumothorax: A Systematic Review of Randomized Controlled Trials

Background

Pleural abrasion has been widely used to control the recurrence of primary spontaneous pneumothorax (PSP). However, controversy still exists regarding the advantages and disadvantages of pleural abrasion compared with other interventions in preventing the recurrence of PSP.

Methods

The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to December 15, 2014 to identify randomized controlled trials (RCTs) that compared the effects of pleural abrasion with those of other interventions in the treatment of PSP. The study outcomes included the PSP recurrence rate and the occurrence rate of adverse effects.

Results

Mechanical pleural abrasion and apical pleurectomy after thoracoscopic stapled bullectomy exhibited similarly persistent postoperative air leak occurrence rates (p = 0.978) and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led to reduced residual chest pain and discomfort (p = 0.001) and a smaller rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the addition of minocycline pleurodesis to pleural abrasion did not reduce the pneumothorax recurrence rate compared with apical pleurectomy (3.8% for both procedures) but was associated with fewer complications. There was no statistical difference in the pneumothorax recurrence rate between mechanical pleural abrasion and chemical pleurodesis with minocycline on either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12; Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24; Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did not reduce the pneumothorax recurrence rate compared with pleural abrasion alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis was associated with more intense acute chest pain. The postoperative overall recurrence rate in patients who underwent staple line coverage with absorbable cellulose mesh and fibrin glue was similar to that with mechanical abrasion after thoracoscopic bullectomy (13.8% vs. 14.2%, respectively; p = 0.555), but staple line coverage resulted in less postoperative residual pain than mechanical abrasion (0.4% vs.3.2%; p<0.0001). Pleural abrasion after thoracoscopic wedge resection did not decrease the recurrence of pneumothorax compared with wedge resection alone (p = 0.791), but the intraoperative bleeding and postoperative pleural drainage rates were higher when pleural abrasion was performed.

Conclusions

In addition to resulting in the same pneumothorax recurrence rate, thoracoscopic pleural abrasion with or without minocycline pleurodesis is safer than apical pleurectomy in the treatment of PSP. However, minocycline pleurodesis with or without pleural abrasion is not any more effective than pleural abrasion alone. Moreover, additional mechanical abrasion is not safer than additional staple line coverage with absorbable cellulose mesh and fibrin glue after thoracoscopic bullectomy because of increased postoperative pain. Additionally, pleural abrasion after thoracoscopic wedge resection should not be recommended for routine application due to the greater incidence of adverse effects than wedge resection alone. However, further large-scale, well-designed RCTs are needed to confirm the best procedure.     

电视胸腔镜在闭合性胸外伤诊治中的应用

目的:探讨电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在闭合性胸外伤中诊断、治疗中的价值。方法:2004年6月～2011年6月选择68例闭合性胸外伤患者,应用VATS进行探查、诊断,同时进行肺修补、肺楔形切除、肋间血管止血、肋骨骨折固定等操作以及小切口辅助手术。结果:68例经VATS探查损伤情况:肺裂伤30例,凝固性血胸15例,肋间血管损伤10例,肋骨骨折需手术复位、固定12例,肺内血肿形成5例,膈疝3例,胸廓内血管损伤2例。VATS行肺修补术25例,肺楔形切除术7例,血管止血术12例,肋骨骨折复位、固定术12例,VATS辅助胸壁小切口肺叶切除术3例,膈疝修补术3例。VATS手术时间25～125 min,平均71.7 min。术后1～7 d胸腔少量积液、积气9例,少量咯血8例。68例随访2～17个月,平均9.2个月,复查胸片显示患肺复张良好,胸腔无积液、积气。结论:闭合性胸外伤患者应用VTAS诊治,可使诊断及时、准确,患者创伤小、恢复快,疗效满意。     

贝伐珠单抗联合化疗治疗晚期非鳞非小细胞肺癌的临床观察

目的:观察贝伐珠单抗联合化疗对晚期非小细胞肺癌患者的疗效、安全性及影像学改变。方法:对2007年至2014年于我院治疗的晚期NSNSCLC(非鳞非小细胞肺癌non-squamous non-small cell lung cancer)患者,给予贝伐珠单抗(15 mg/kg或7.5mg/kg)联合化疗(紫杉醇175 mg/m~2,d1,卡铂AUC=5或6,d1,q3 w)6周期及贝伐珠单抗维持治疗(15 mg/kg或7.5 mg/kg,d1,q3w)。观察疗效、不良反应、肺部病灶空洞改变的情况、恶性胸腔积液的治疗效果及部分患者EGFR、KRAS基因突变状况。结果:共观察26例患者,均接受贝伐珠单抗联合化疗,17例行贝伐珠单抗维持治疗。部分缓解(partial response,PR)、疾病稳定(stable disease,SD)、疾病进展(disease progression,PD)率分别为53.8%、42.3%、3.8%。中位无进展生存期(progression free survival,PFS)为11.0个月,中位总生存期(overall survival,OS)达25.8个月。26例患者中15.4%治疗后病变发生空洞改变,空洞组的2年、3年生存率略高于无空洞组,但无统计学差异(P值分别为0.586、0.509)。13例患者伴有恶性胸腔积液,胸腔积液的疾病控制率为100%。11例患者标本可进行EGFR基因检测,敏感突变占36.4%,未突变占63.6%。对10例患者标本行KRAS基因检测,均为突变阴性。不良反应包括骨髓抑制、消化道反应、鼻衄、咯血、高血压、蛋白尿等。大多数不良反应程度较轻,可控制。结论:贝伐珠单抗联合化疗治疗晚期NSNSCLC患者疗效确切,副反应可耐受,控制恶性胸腔积液效果较好。肺部病灶空洞改变的临床意义有待进一步研究。     

Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients

ABSTRACT: BACKGROUND: Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via minithoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. METHODS: Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. RESULTS: Forty-eight patients (64.7% male), with a mean age of 55.20 +/- 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 +/- 1.79 months. One- and 2-year survival rates were 45 +/- 7% and 18 +/- 5%, respectively. CONCLUSION: Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.     

252 例胸膜恶性肿瘤的临床病理分析

目的：探讨胸膜恶性肿瘤的病理类型、肿瘤所占比例、临床病理特征及鉴别诊断。方法：结合病理形态学及免疫组化方法对 252 例胸膜恶性肿瘤进行诊断及鉴别诊断。结果：252 例胸膜恶性肿瘤包括胸膜穿刺活检120 例,胸腔镜活检25 例,伴有胸膜转 移的恶性胸水107 例;男性143 例,女性109 例,年龄19-87 岁,平均年龄59.9 岁。临床主要症状是胸闷、气短、咳嗽、胸痛等。CT 表现为胸膜增厚、胸水(90%)、多发或单发胸膜结节和原发器官占位性病变。活检病例中,转移性癌86 例(34.1%),包括肺腺癌64 例(25.4%),小细胞癌11 例(4.4%),鳞癌11 例(4.4%),恶性间皮瘤47 例(18.7%),滑膜肉瘤9 例(3.6%),非霍奇金淋巴瘤3 例(1.2%); 恶性胸水病例病例中转移性癌95 例(37.7%),包括肺腺癌85 例(33.7%),小细胞癌6 例(2.4%),鳞癌2 例(0.8%),乳腺腺癌2 例 (0.8%),恶性间皮瘤8 例(3.2%),非霍奇金淋巴瘤4 例(1.6%)。结论：胸膜恶性肿瘤中以转移性腺癌多见,其次为恶性间皮瘤,结合 形态学及免疫组织化学检测不同标志物的表达有助于诊断胸膜恶性肿瘤的种类。