Avtor/Urednik		Crnjac, Anton
Naslov		Kirurške možnosti zdravljenja malignih plevralnih izlivov karcinoma dojke: primerjava metod
Prevedeni naslov		Surgical options for treating malignant pleural effusion in patients with breast carcinoma: comparison of methods
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 79, št. 3
Leto izdaje		2010
Obseg		str. 272-9
Jezik		slo
Abstrakt		Background: Recurrent malignant pleural effusion (MPE) is a common complication of breast carcinoma causing an irritating cough and pain due to the fluid exerting pressure on the lungs. As the systemic therapy fails in approximately half of the patients with pleural eff usion, one of the palliative methods is used. Lately, the most commonly used procedure is the chemical pleurodesis with talc or the thoracoscopic mechanical pleurodesis. The aim of the study was to prove certain advantages of the latter method, especially at lower MPE pH values, since the chemical pleurodesis in those cases does not provide acceptable results. Methods: This prospective, randomized study included 87 patients with breast carcinoma and morphologically proven malignant pleural effusion. Patients were divided into two groups according to palliative treatment: the TMP group (thoracoscopicmechanical pleurodesis) and the TP group (talc pleurodesis). There were also four subcategories according to the pH value of malignant pleural effusion (>/= 7.3, < 7.3). Results: The effectiveness (no recurrence of pleural effusion) of TP (91%) and TMP (92%) was identical in patients with a MPE pH value above 7.3. However, in patients with pH value under 7.3 TMP was more successful (81%) than TP (55%). Th e lowest pH values at which the methods proved successful were 7.06 in TMP and 7.25 in TP. Conclusion: TP proved to be a more useful palliative method in patients with pH values above 7.3 due to its simplicity. On the other hand, TMP is more successful at lower pH values. Furthermore, TMP is also very effective in the group of patients with higher pH values, especially for handling cytologically or histologically unconfirmed malignant pleural eff usions and in suspected adhesions in the pleural space.
Izvleček		Izhodišča: Pogost zaplet karcinoma dojke je ponavljajoči se maligni plevralni izliv (MPI), ki povzroča bolnicam zaradi pritiska na pljuča dihalne težave, dražeč kašelj in bolečine. Ker pri približno polovici bolnic s plevralnim izlivom le tega ne moremo sanirati s sistemskim zdravljenjem, uporabimo enega od načinov blažilnega zdravljenja, v zadnjem času najpogosteje s kemično plevrodezo s talkom (KPT) ali torakoskopskomehansko plevrodezo (TMP). V študiji smo želeli dokazati določene prednosti TMP, predvsem pri nižjih vrednostih pH MPI, ko KPT ne daje zadovoljivih rezultatov. Metode: V prospektivno randomizirano raziskavo smo vključili 87 bolnic s karcinomom dojke in z morfološko potrjenim MPI. Bolnice smo razporedili v dve skupini glede na vrsto blažilnega posega: skupino TMP (torakoskopska mehanska plevrodeza) in skupino KPT (kemična plevrodeza s talkom) ter štiri podskupine glede na vrednosti pH MPI (>/= 7,3; < 7,3). Rezultati: Uspešnost (brez ponovitve MPI) KPT (91%) in TMP (92%) je bila pri bolnicah z vrednostjo pH MPI nad 7,3 identična. Pri bolnicah z vrednostjo pH pod 7,3 pa je bila TMP uspešnejša metoda (81%) kot KPT (55%). Najnižji vrednosti pH MPI, pri katerih sta bili metodi še uspešni, sta bili 7,06 pri TMP in 7,25 pri KPT. Zaključki: Pri vrednostih pH MPI nad 7,3 je KPT zaradi svoje enostavnosti uporabnejša blažilna metoda. TMP, ki je uspešnejša pri nižjih vrednostih pH, pa ima tudi v skupini bolnic z višjimi vrednostmi pH svoje nesporno mesto, predvsem pri reševanju citološko ali histološko nepotrjenih MPI in pri sumu na zarastline v plevralnem prostoru.
Deskriptorji		BREAST NEOPLASMS PLEURAL EFFUSION, MALIGNANT PLEURODESIS PALLIATIVE CARE