Burçin ÇELİK, Yüksel BEK, Ahmet BAŞOĞLU, Sedat DEMİRCAN

Malign plevral effüzyonda farklı plörodezis yöntemleri ile talk ve oksitetrasiklinin karşılaştırılması

Amaç: Bu çalışmada, malign plevral effüzyonun (MPE) palyatif tedavisinde plörodezisin farklı yöntemler ve farklı sklerozan ajanlar kullanılarak klinik yanıtının değerlendirilmesi amaçlandı. Materyal ve Metod: Mayıs 2001 - Eylül 2003 arasında malign plevral effüzyon nedeniyle plörodezis uygulanan 47 olgu çalışmaya alındı. Hastalar Karnofski performans durumu 60 ve üzerinde, sempiomatik, bir aydan fazla sağ kalım ve tam akciğer ekspansiyonu sağlanabilen olgulardan seçildi. Olgular dört gruba ayrıldı. Alınan plevral sıvı ve serum örneklerinde LDH, total protein, glukoz, sitoloji çalışıldı. Grup l (n = 16) olgulara tüp torakostomi-oksitetrasiklin (70 mg/kg), Grup 2 (n = 11) olgulara torakoskopi-plevral abrazyon, Grup 3 (n = 10) olgulara torakoskopi talk (4 gr), Grup 4 (n = 10) olgulara tüp torakostomi-taİk (4 gr) uygulandı. Plörodezis başarısı 24. saat, 1. ay, 3. ay, 6. ayda çekilen göğüs radyografisi ve/veya göğüs bilgisayarlı tomografi ile değerlendirildi. Bulgular: Olguların, 34'ü kadın, 13'ü erkek idi. Yaş ortalaması 58 ± 12.2 (18-71) yıl idi. Ortalama Karnofski performans durumu 76 ± 7.9 bulundu. Olguların 21'inde (%45) MPE tanısı torakoskopik biyopsi ile konuldu. En sık MPE nedeninin meme kanseri (%40) olduğu görüldü. Gruplar arasında plevral sıvı, serum, pleural sıvı/serum değerleri bakımından istatistiksel olarak önemli bir fark tespit edilmedi. Göğüs tüpü süresinin Grup 3'te (4.4 ±1.8 gün) diğer gruplara göre daha kısa olduğu tespit edildi, bu süre istatistiksel olarak anlamlı bulundu (p = 0.026). Gruplarda plörodezis başarısı değerlendirilmesinde tam cevap Grup l 'de %67, Grup 2'de %77, Grup 3'te %85 ve Grup 4'te %74 olarak bulundu. Olguların 28'inde (%59) yan etki görüldü. En sık yan etki ağrıydı (%34). Ciddi yan etki olarak torakoskopi talk uygulanan 2 olguda reekspansiyon ödemi görüldü. Sonuç: Malign plevral effüzyonda sağ kalım süresi kısa olduğundan, semptomatik hastalarda tedavide palyatif amaçlı plörodezis uygulanır. Plörodezis işleminde hasta ve uygulanacak yöntemin seçimi oldukça önemlidir. Günümüzde, torakoskopi MPE'nin tanı ve tedavisinde tercih edilen etkin bir yöntem, talk etkin bir sklerozan ajandır.

Comparison of talc and oxytetracycline with different pleurodesis methods in treatment of malignant pleural effusion

Background: In this study, we aimed to evaluate clinical results of pleurodesis by using different methods and sclerosant agents in treatment of malignant pleural effusion (MPE). Methods: Forty-seven cases who underwent pleurodesis because of MPE were studied between May 2001 and September 2003. Cases were selected among the ones who had Karnofski performance status equaled to or over 60, symptomatic, expected survival was over one month, and full expansion in lungs was possible. Cases were divided into four groups. LDH, total protein, glucose, cytology were studied in pleural fluid and serum samples. Tube thoracostomy and oxytetracycline (70mg/kg) was applied to Group 1 (n = 16), thoracoscopy and pleural abration was applied to Group 2 (n = 11), thoracoscopy and talc (4 gr) was applied to Group 3 (n = 10), and tube thoracostomy and talc (4 gr) was applied to Group 4 (n = 10). Success rate of pleurodesis was evaluated by chest radiography and/or chest computerized tomography taken after 24 hours, 1 month, 3 months and 6 months. Results: Thirty-four of the cases were female, and 13 was male with mean age 58 ± 12.2 years (ranged 18 to 71 years). Mean Karnofski performance status was 76 + 7.9. Malignant pleural effusion was diagnosed by thoracoscopic biopsy in 21 (45%) of the cases. The most frequent reason for MPE was found to be breast cancer (40%). Between groups, no significant difference could be found in pleural fluid, serum, pleural fluid/serum values. Duration of tube thoracostomy in Group 3 (4.4 +1.8 days) was observed to be shorter than of the other groups and it was statistically significant (p = 0.026). In evaluation of success rate of pleurodesis in groups, success was as 67% in Group 1, 77% in Group 2, 85% in Group 3 and 75% in Group 4. In 28 (59%) cases adverse effects was observed and pain (34%) was the most frequent adverse effect. Reexpansion edema was observed as a serious adverse effect in two cases who underwent thoracoscopy-talc pleurodesis. Conclusions: Because of the short survival time in MPE, in symptomatic patients pleurodesis is applied as a palliative treatment. In pleurodesis, the selection of the patient and the method to be applied is very important. Today, thoracoscopy is an effective method in diagnosis and treatment of MPE, and talc is an effective sclerosant agent.

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