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MINIMALLY INVASIVE TREATMENT OF METASTATIC PLEURITIS.
Severgin V., Dubinina V., Polyak S., Shipulin P., Lukianchuk O., Agrahari A.
Objective. Metastatic pleuritis is one of the most frequent complications of malignancy. The course of the disease in more than half of the patients with disseminated forms of cancer is complicated with the development of metastatic pleuritis. One of the key moments in the treatment of metastatic pleuritis is the formation of pleurodesis. The most effective of the known methods is chemical pleurodesis with talc (90%). Suggested method allows us not only to create a pleurodesis, but also to maximize the chance in removal of metastases of the parietal pleura.
The aim of the study is to assess the results of thoracoscopic treatment of metastatic lesions of the pleura.
Methods. This method is used by us in the treatment of 34 patients with metastatic pleuritis. Primarily these patients had lung cancer - 24 patients, breast cancer - 8 patients, ovarian cancer - 2 patients. To create pleurodesis and destruction of metastases, we used radiofrequency ablation device Fotek-150 with monopolar electrode. Under control of the thoracoscopy the electrode was introduced thou the thoracoport metastasis on the parietal pleura. Then current of high frequency was supplied with power of 60 W, exposure time - 1 min. Within a radius of 3 cm around the electrode the coagulation zone with the destruction of metastatic node was formed. Operation was finished with pleural cavity drainage followed by 30 mg of bleomycine introduced into the pleural cavity.
Results. Recurrence of metastatic pleuritis appeared in 3 patients after 1 and 2 months after surgical intervention. In 91,2% of the patients effective pleurodesis with the decrease in pleural exudation during 5 months was achieved.
Conclusions: 1) Use of radiofrequency ablation combined with the use of bleomycine not only allow to achieve stable pleurodesis but also liquidate metastasis on the parietal pleura. 2) This method requires additional clinical research.