胸腔镜检查及滑石粉喷洒治疗肝性胸水
Thoracoscopy and talc poudrage in the management of hepatic hydrothorax.
作者信息
Milanez de Campos J R, Filho L O, de Campos Werebe E, Sette H, Fernandez A, Filomeno L T, Jatene F B
机构信息
Division of Thoracic Surgery, Hospital Israelita Albert Einstein and Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil.
出版信息
Chest. 2000 Jul;118(1):13-7. doi: 10.1378/chest.118.1.13.
STUDY OBJECTIVE
To determine indications, limitations, morbidity and mortality of surgical thoracoscopy for management of hepatic hydrothorax, a rare, but often recurrent, complication in cirrhotic patients.
PATIENTS AND METHODS
From May 1985 through May 1999, 10 men and 8 women, with a mean age of 57.6 years (range, 26 to 76 years), underwent 21 therapeutic thoracoscopies to achieve pleurodesis by application of talc.
RESULTS
The procedure was effective in 10 of 21 procedures. There were four recurrences (19. 1%) that were retreated, with only one being successful. In this specific group, we detected high morbidity (57.1%) and mortality (38.9%) during the follow-up period of 3 months. Diaphragmatic defects were localized and closed five times (23.8%). Hospital stay was approximately 15 days (range, 5 to 41 days).
CONCLUSION
The procedure appears to be indicated for these fragile patients, especially when medical therapy fails. Immediate efficacy was 47.6%, increasing to 60% with videothoracoscopy and suture of the diaphragmatic defect. However, morbidity and mortality were high.
研究目的
确定外科胸腔镜治疗肝性胸水（肝硬化患者中一种罕见但常复发的并发症）的适应症、局限性、发病率和死亡率。
患者与方法
1985年5月至1999年5月，10名男性和8名女性，平均年龄57.6岁（范围26至76岁），接受了21次治疗性胸腔镜检查，通过应用滑石粉实现胸膜固定术。
结果
21次手术中有10次有效。有4例复发（19.1%），再次进行了治疗，仅1例成功。在这个特定组中，我们在3个月的随访期内检测到高发病率（57.1%）和死亡率（38.9%）。膈肌缺损定位并封闭了5次（23.8%）。住院时间约为15天（范围5至41天）。
结论
该手术似乎适用于这些脆弱的患者，尤其是在药物治疗失败时。即时有效率为47.6%，通过电视胸腔镜检查和膈肌缺损缝合，有效率提高到60%。然而，发病率和死亡率较高。
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