Abstract
Purpose
The purpose of this technical report is to describe the technique of intratumoral injection of hypertonic glucose combined with low-negative pressure drainage to treat refractory pneumothorax (RP) after microwave ablation (MWA) of lung tumors.
Materials and Methods
Between September 2016 and May 2018, four patients who developed RP after MWA of peripheral lung cancer were managed by a combined method, including intratumoral injection of hypertonic glucose and catheter drainage under low-negative pressure. Blood gas values were recorded and compared before the treatment and one-week posttreatment. All patients were followed up for at least one month to monitor the possible recurrence of pneumothorax by chest CT.
Results
All patients were successfully treated. One patient received the intratumoral injection of hypertonic glucose twice, while the remaining three patients received a single injection. The technical success rate was 100%. Dyspnea related to RP was significantly relieved in all patients, and PaO2 and SaO2 values were higher than those measured before treatment. No patient suffered a recurrence of pneumothorax during the follow-up.
Conclusion
The combined method of intratumoral injection of hypertonic glucose and continuous catheter drainage under low-negative pressure might be an effective method to manage RP caused by MWA.
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References
Odaka M, Akiba T, Mori S, Asano H, Yamashita M, Kamiya N, et al. Thoracoscopic surgery for refractory cases of secondary spontaneous pneumothorax. Asian J Endosc Surg. 2013;6(2):104–9.
Kress JI, Sklenar SC, Pociuli O, Brammen C, Eggeling S. Successful management of a massive bronchopleural fistula with endobronchial valves in a case of perforated central lung cancer: a case report. Zentralbl Chir. 2016;141(1):102–4.
Thivolet A, Menassel B, Chatté G, et al. Delayed bronchocutaneous fistula without pneumothorax following a microwave ablation of a recurrent pulmonary metastasis. Cardiovasc Interv Radiol. 2018;41(2):340–3.
Li W, Huang L, Han Y, Zhou Y, Lu Q, Li X. Bronchopleural fistula after non small cell lung cancer radiofrequency ablation: what it implying to us. Diagn Pathol. 2013;8:202.
Chang SH, Kang YN, Chiu HY, Chiu YH. A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest. 2018;153(5):1201–12.
Izaaryene J, Cohen F, Souteyrand P, Rolland PH, Vidal V, Bartoli JM, et al. Pathological effects of lung radiofrequency ablation that contribute to pneumothorax, using a porcine model. Int J Hyperth. 2017;33(7):713–6.
Kennedy SA, Milovanovic L, Dao D, Farrokhyar F, Midia M. Risk factors for pneumothorax complicating radiofrequency ablation for lung malignancy: a systematic review and meta-analysis. J Vasc Interv Radiol. 2014;25(11):1671–81.
Butler FK, Holcomb JB, Shackelford S, et al. Management of suspected tension pneumothorax in tactical combat casualty care: TCCC guidelines change 17-02. J Spec Oper Med. 2018;18(2):19–35.
Vuong NL, Elshafay A, Thao LP, et al. Efficacy of treatments in primary spontaneous pneumothorax: a systematic review and network meta-analysis of randomized clinical trials. Respir Med. 2018;137:152–66.
Walker SP, Maskell N. Pneumothorax management-chest drain or needle aspiration. J Thorac Dis. 2017;9(10):3463–4.
Maskell NA. Pneumothorax management: time to improve the evidence base. Thorax. 2017;72(12):1065–6.
Kim MJ, Park I, Park JM, Kim KH, Park J, Shin DW. Systematic review and meta-analysis of initial management of pneumothorax in adults: intercostal tube drainage versus other invasive methods. PLoS One. 2017;12(6):e0178802.
Habibi B, Achachi L, Hayoun S, Raoufi M, Herrak L, Ftouh ME. Management of spontaneous pneumothorax: about 138 cases. Pan Afr Med J. 2017;26:152.
Tsai TM, Lin MW, Li YJ, et al. The size of spontaneous pneumothorax is a predictor of unsuccessful catheter drainage. Sci Rep. 2017;7(1):181.
Pompili C, Salati M, Brunelli A. Chest tube management after surgery for pneumothorax. Thorac Surg Clin. 2017;27(1):25–8.
Peng ZM, Wu ES. Clinical value of hypertonic glucose injection in the treatment of recurrent pneumothorax. Hunan Yi Ke Da Xue Xue Bao. 2002;27(3):256–8.
Tsukioka T, Inoue K, Oka H, Mizuguchi S, Morita R, Nishiyama N. Intraoperative mechanical and chemical pleurodesis with 50 % glucose solution for secondary spontaneous pneumothorax in patients with pulmonary emphysema. Surg Today. 2013;43(8):889–93.
Miura H, Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Nishimura T. Pneumothorax induced by radiofrequency ablation for hepatocellular carcinoma beneath the diaphragm under real-time computed tomography-fluoroscopic guidance. Acta Radiol. 2010;51(6):613–8.
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Wang, D., Li, X. & Yu, W. Intratumoral Injection of Hypertonic Glucose in Treating Refractory Pneumothorax Caused by Microwave Ablation: a Preliminary Study. Cardiovasc Intervent Radiol 42, 915–919 (2019). https://doi.org/10.1007/s00270-019-02195-9
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DOI: https://doi.org/10.1007/s00270-019-02195-9