THE VALUE OF TALCAGE BY THORACOSCOPY IN THE SYMPTOMATIC TREATMENT OF RECURRENT PLEURAL EFFUSION

  • 1 January 1989
    • journal article
    • research article
    • Vol. 6  (2) , 133-140
Abstract
From the data of a retrospective study the authors assess the value of pleural symphysis by talc in the symptomatic treatment of recurrent pleural effusion. 300 patients, 254 of whom were suffering from pleural effusion secondary to cancer and 48 of whom had non-cancerous pleural effusion, were subjected to a thoracoscopy under local anaesthetic allowing the instillation of 5-10 mls of talc powder followed by aspiration drainage for 4-8 days. Out of 270 evaluable cases, an immediate positive result (defined as the absence of any recurrence of the pleural effusion at the drainage site) was obtained in 251 cases or 93% .+-. 3% (being 92.1% .+-. 3.5% of the cases of pleural cancer and 97.7 .+-. 4.5% in cases of non-cancerous pleural effusion). At the end of 6 months there was no recurrence of the effusion in 80.6% of cases. There were 19 early failures (7% .+-. 3%) and 25 late failures of whom 9 benefitted from a further attempt at a pleural symphysis (either a pleurectomy, or injection of talc in suspension, or new talc therapy by thoracoscopy). On the whole the complications were minor : pain, fever and rarely more serious : empyema in 6 cases and cancerous nodules down the drainage line in 10 cases. There had been 15 deaths (5.3% .+-. 2.6%) during the period of drainage in some very weak and fragile patients. Pleural talcage leads to an improvement in dyspnoea in 82% .+-. 7.4% of cases and the general condition was improved in 54% .+-. 9.8%. This technique is useful because it gives excellent results in the palliative treatment of recurrent pleural effusion when treatment based on the aetiology is either insufficient or non-existent.

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