腹膜透析并发胸腹瘘一例并文献复习  

A Case of Peritoneal Dialysis Complicated with Thoracoabdominal Fistula and Literature Review

作　　者：范妙仪[1,2] 佘宁兰[1,2] 韩天瞾[1,2] 童玉娜[1,2] 龚蓉[1,2] 

机构地区：[1]重庆医科大学附属成都第二临床学院 [2]成都市第三人民医院肾内科,四川省成都市610031

出　　处：《中国全科医学》2014年第25期3031-3033,共3页Chinese General Practice

基　　金：四川省卫生厅科研基金(120541)

摘　　要：腹膜透析(PD)是终末期肾病患者常用的肾脏替代治疗方法之一,因其居家可自行管理、操作简便、节省医疗资源,适合在我国社区和偏远地区推广应用。并发胸腹瘘是PD少见的并发症,严重影响PD患者的透析质量及生存状况。本文报道了一例采用滑石粉胸膜固定术联合小剂量递增式PD治疗PD并发胸腹瘘并随访24个月的病例,通过回顾本例患者的临床诊疗经过,提示PD患者出现单侧不明原因的大量胸腔积液时需高度警惕并发胸腹瘘。复习相关文献,由于胸腹交通常在右侧,如果X线胸片或胸部CT检查显示存在右侧胸腔积液,强烈提示本病。诊断性胸腔穿刺亦有助于区分积液的性质。当怀疑有胸腹瘘时,可腹腔内给予美蓝,若胸腔积液中亦有美蓝即可确诊。通过腹腔注射99Tcm聚集清蛋白或99Tcm硫胶,抽取胸腔积液测定放射性,亦能确诊存在胸腔渗漏。近年来有报道电视胸腔镜手术(VATS)也可作为诊断手段。诊断明确时,采用传统的滑石粉胸膜固定术联合小剂量递增式PD,不仅能减少再发胸腹瘘风险,还能使患者获得长期较好的生存质量。Peritoneal dialysis （PD） is one of the common renal replacement therapies in patients with end - stage re- nal diseases. Because of its convenient home self management, simple operation saving medical resources, it is suitable for popularization and application in communities and remote areas. Thoracoabdominal fistula, a rare complication of PD, seriously affects dialysis quality and the survival status of PD patients. This paper reports a case of PD patients complicated with thoracoabdominal fistula who was treated with talc powder pleurodesis in combination with small dose of incremental PD and received 24 months＇ fol- low- up. By reviewing the clinical diagnosis and treatment, the report suggests that massive pleural effusion with unknown cause on one side might be a high alert with thoracoabdominal fistula. The chest and abdomen junction often on the right side, if the chest X - ray or chest computer tomography （CT） shows the presence of right pleural effusion, it is strongly suggestive of the dis- ease. Diagnostic thoracentesis also helps to distinguish effusion. After intraperitoneal administration of methylene blue, if the meth- ylene blue can be found in pleural effusion, thoracoabdominal fistula can be confirmed. Thoracic leakage can also be diagnosed by intraperitoneal injection of 99Tcm albumin aggregated or 99TcZ sulfur colloid and extracting pleural effusion to determine radioac- tive. In recent years it is reported on TV thoracoscope （VATS） can be used as a means of diagnosis. When a clear diagnosis is made, the traditional talc pleurodesis in combination with small dose of incremental PD can reduce the risk of recurrence of thoracoabdominal fistula, and make the patients get better and long- term survival quality.

关 键 词：腹膜透析 胸腔积液 滑石粉 胸膜固定术 胸腹瘘 

分 类 号：R459.51[医药卫生—治疗学]