Sharma Sat, Smith Robert, Al-Hameed Fahad
Section of Respirology, University of Manitoba, Winnipeg, Canada.
Can Respir J. 2002 Sep-Oct;9(5):335-7. doi: 10.1155/2002/740878.
Pleural disease is a common pulmonary manifestation of systemic lupus erythematosus (SLE) that usually responds to corticosteroids and other immunosuppressive agents. In the present report, a new approach, pleural decortication, was used in a patient with medically refractory chronic pleuritis secondary to severe SLE. A 26-year-old woman with known SLE developed progressive dyspnea and pleuritic chest pain over several months. The other systemic manifestations of her lupus were controlled with cyclophosphamide and prednisone. A computed tomography scan revealed a persistent, small, loculated right pleural effusion; pleural thickening; and atelectasis of the right middle and lower lobes. Pulmonary function tests showed a severe restrictive defect. The patient was disabled by her severe dyspnea despite maximal medical therapy, and, therefore, surgery was considered. A right thoracotomy revealed entrapment of the right lung by dense visceral pleura. Decortication was performed. On pathology, pleuritis with vascular pleural adhesions was found. No lupus pneumonitis was noted. Postoperatively, a significant clinical improvement in dyspnea was evident within several weeks. On a 6 min walk test, the patient achieved 384 m with a Borg dyspnea scale rating of 2 compared with 220 m and a Borg dyspnea scale rating of 4 preoperatively. Her forced vital capacity improved from 24% predicted to 47% predicted, and her total lung capacity improved from 35% predicted to 54% predicted. Medical therapy of systemic lupus erythematosus has been proven to be effective in controlling pleuritis in most cases. However, in the event of refractory pleuritis or pleural thickening, decortication may be a viable alternative.
胸膜疾病是系统性红斑狼疮（SLE）常见的肺部表现，通常对皮质类固醇和其他免疫抑制剂有反应。在本报告中，一种新的方法——胸膜剥脱术，被应用于一名患有严重SLE继发的药物难治性慢性胸膜炎患者。一名已知患有SLE的26岁女性在数月内出现进行性呼吸困难和胸膜炎性胸痛。她狼疮的其他全身表现通过环磷酰胺和泼尼松得到控制。计算机断层扫描显示右胸腔持续存在小的局限性胸腔积液、胸膜增厚以及右中、下叶肺不张。肺功能测试显示严重的限制性缺陷。尽管进行了最大程度的药物治疗，患者仍因严重呼吸困难而致残，因此考虑进行手术。右开胸手术显示右肺被致密的脏层胸膜包裹。进行了胸膜剥脱术。病理检查发现伴有血管性胸膜粘连的胸膜炎。未发现狼疮性肺炎。术后数周内，呼吸困难有明显的临床改善。在6分钟步行试验中，患者达到384米，Borg呼吸困难量表评分为2，而术前为220米且Borg呼吸困难量表评分为4。她的用力肺活量从预测值的24%提高到47%，总肺容量从预测值的35%提高到54%。系统性红斑狼疮的药物治疗在大多数情况下已被证明对控制胸膜炎有效。然而，对于难治性胸膜炎或胸膜增厚，胸膜剥脱术可能是一种可行的选择。
