胸腔灌注榄香烯治疗腹膜透析合并胸腹瘘患者的疗效观察  

Effect of pleural infusion of elemene in treatment of patients with peritoneal dialysis complicated with thoracoabdominal fistula

作　　者：徐兰[1] 王昆仑 于佳丽 熊美丽 付欣 吴宪鸣[1] XU Lan;WANG Kun-lun;YU Jia-li;XIONG Mei-li;FU Xin;WU Xian-ming(Department of Nephrology,the Third People's Hospital of Zhengzhou,Zhengzhou 450000,China;Department of Radiotherapy,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州市第三人民医院肾内一科,郑州450000 [2]郑州大学附属肿瘤医院放疗科,郑州450052

出　　处：《医药论坛杂志》2023年第12期29-33,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(2018020758)。

摘　　要：目的观察CT腹膜腔造影在腹膜透析(peritoneal dialysis,PD)患者合并胸腹瘘的诊断效果,评估榄香烯胸腔灌注对其治疗的有效性与安全性。方法回顾性分析2016年10月至2020年9月在郑州市第三人民医院肾内科行榄香烯胸腔灌注治疗的15例PD合并胸腹瘘患者的临床资料。应用CT腹膜腔造影确诊胸腹瘘,将对比剂碘海醇注射液(100 mL,30 g)注入低钙腹膜透析液后灌腹,并于留腹1 h、4 h行胸部CT扫描,采用t检验比较两个时间点CT值的变化。确诊胸腹瘘后,再次行胸腔穿刺术,将胸水充分引流后沿穿刺针向胸腔内行榄香烯灌注治疗,观察患者治疗后胸部CT扫描结果及治疗效果。结果对比剂留腹4 h的胸水CT值比留腹1 h增长了6~48 HU,平均(21.27±12.41)HU,可确诊胸腹瘘。15例患者在榄香烯胸腔灌注治疗后,胸水均明显减少或消失,院外随访期间所有患者胸水均消失并无复发,中位随访时间17个月。结论CT腹膜腔造影术在PD疑似胸腹瘘的患者中可明确诊断。榄香烯胸腔灌注治疗PD合并胸腹瘘有效性和安全性较高,特别适合于基础疾病重,心肺功能差,无法耐受胸腔镜下手术修补胸腹瘘的患者。Objective To observe the diagnostic effect of CT peritoneal cavity angiography in patients with peritoneal dialysis(PD) complicated with pleural fistula,and to evaluate the efficacy and safety of the treatment of olive pleural perfusion.Methods The clinical data of 15 patients with PD complicated with thoracoabdominal fistula who received pleural infusion of olive in the Department of Nephrology,the Third People's Hospital of Zhengzhou from October 2016 to September 2020 were retrospectively analyzed.CT peritoneal cavity angiography was used to confirm thoracoabdominal fistula.The contrast agent iodohexol injection(100 mL,30 g) was injected into low-calcium peritoneal dialysis solution,followed by abdominal perfusion,and chest CT scan was performed at 1 and 4 hours after abdominal retention.t-test was used to compare the changes of CT values at two time points.After the diagnosis of thoracoabdominal fistula,thoracopuncture was performed again,pleural fluid was fully drained,and the puncture needle was extended into the chest cavity for the infusion of olive,and the results of chest CT scan and therapeutic effect were observed.Results The CT value of pleural fluid at 4 hours after abdominal retention with contrast agent increased by 6-48HU compared with that at 1 hour,with an average of(21.27±12.41) HU,which could confirm the diagnosis of thoracoabdominal fistula.The pleural effusion of 15 patients was significantly reduced or disappeared after the pleural infusion of olive.During the out-of-hospital follow-up,pleural effusion disappeared without recurrence in all patients,with a median follow-up time of 17 months.Conclusion CT peritoneal radiography can be used for definite diagnosis in PD patients with suspected thoracoabdominal fistula.The efficacy and safety of the treatment of PD with thoracoabdominal fistula by pleural infusion of olive is relatively high,which is especially suitable for patients with serious underlying diseases,poor cardiopulmonary function,and unable to tolerate thoracoscopic surgery to r

关 键 词：胸腹瘘 CT腹膜腔造影 榄香烯 腹膜透析 

分 类 号：R459.5[医药卫生—治疗学]