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Vol. 24. Núm. 5.
Páginas 209-214 (Septiembre - Octubre 1988)
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Vol. 24. Núm. 5.
Páginas 209-214 (Septiembre - Octubre 1988)
DOI: 10.1016/S0300-2896(15)31815-9
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Tratamiento del derrame pleural maligno
Treatment of malignant pleural effusion
Visitas
...
R. Rami Porta
Servicio de Cirugía Torácica. Hospital Clínico y Provincial. Barcelona
J.L. Bravo Bravo*
* Sección de Cirugía Torácica. R.S. Ntra. Sra. de Covadonga. Oviedo
Información del artículo

Para el tratamiento del derrame pleural maligno se dispone de varias modalidades terapéuticas. 1) Técnicas evacuadoras: los diuréticos, las toracocentesis y el drenaje con tubo eliminan el derrame, pero la recidiva suele ser la regla. Las derivaciones pleuro-venosas y pleuro-peritoneales, así como los reservorios para toracocentesis repetidas, están en fase de experimentación clínica y su uso se restringe a pacientes en mal estado general que no soportarían tratamientos más agresivos. 2) La radioterapia está indicada ante la presencia de adenopatías mediastínicas, linfoma o atelectasia pulmonar por obstrucción tumoral endobronquial. 3) La pleurectomía se reserva para pacientes con buen estado general, sin otras metástasis, cuando ha fracasado el tratamiento intrapleural. 4) Terapia intracavitaria: los productos sinfisantes, sobre todo el talco y el clorhidrato de tetraciclina, son los más indicados por producir pleurodesis duradera. Es la modalidad terapéutica más empleada por su elevada eficacia y baja morbilidad.

Many therapeutic modalities exist to manage the malignant pleural effusion. 1. Evacuative techniques: Diuretics, thoracocentesis and drainage with tube remove the effusion but recurrency is the rule. The pleuro-venous and pleuro-peritoneal bypass as well as the reservoir for repeated thoracocentesis are in clinical experimental stage and their use is restricted to patients in bad conditions who probably did not undergo a more aggressive treatment. 2. When mediastinal adenopathies, lymphoma or pulmonary atelectasia are present, radiotherapic treatment is indicated. 3. The pleurectomy is reserved for the patients in good condition with no other metastases, when the intrapleural treatment has failed. 4. Intracavitary therapy: the symphisant products, such as talc and tetracycline hydrochoride, are the most indicated to produce a durable pleurodesis. This is the most employed therapeutic modality owing to its high efficacy and low morbidity.

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