Chow Kai Ming, Szeto Cheuk Chun, Li Philip Kam-Tao
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Semin Dial. 2003 Sep-Oct;16(5):389-94. doi: 10.1046/j.1525-139x.2003.16080.x.
Hydrothorax as a result of pleuroperitoneal communication occurs in approximately 2% of continuous ambulatory peritoneal dialysis (CAPD) patients. Although our understanding of its mechanisms is incomplete, it is apparent that the key to successful therapy is obliteration of a transdiaphragmatic route of dialysate leakage (pleuroperitoneal communication), possibly coupled with reduction of intra-abdominal pressure. This review corroborated the findings from 10 major population-based case series in which 60 of the 104 cases (58%) were able to resume long-term peritoneal dialysis (PD). Temporary interruption of PD alone was successful in half of them. As compared to this conservative approach, as well as chemical pleurodesis via intercostal chest drain, video-assisted thoracoscopic intervention (including direct pleurodesis and diaphragmatic repair) has shown a promising role. Efficacy of thoracoscopic treatment has been confirmed by several case series from various centers and the demonstration of a success rate in excess of 90%. With accumulating experience using the thoracoscopic technique, it remains to be seen whether this mode of treatment will obviate the traditional closed pleurodesis.
因胸膜腹膜相通导致的胸腔积液发生于约2%的持续性非卧床腹膜透析（CAPD）患者中。尽管我们对其机制的理解尚不完整，但显然成功治疗的关键在于消除透析液渗漏的经膈途径（胸膜腹膜相通），可能还需降低腹腔内压力。本综述证实了10项主要基于人群的病例系列研究结果，其中104例中有60例（58%）能够恢复长期腹膜透析（PD）。仅暂时中断PD在其中一半患者中取得成功。与这种保守方法以及通过肋间胸腔引流进行化学性胸膜固定术相比，电视辅助胸腔镜干预（包括直接胸膜固定术和膈肌修复）已显示出有前景的作用。来自各个中心的多个病例系列证实了胸腔镜治疗的疗效，且成功率超过90%。随着胸腔镜技术经验的积累，这种治疗方式是否会取代传统的闭式胸膜固定术还有待观察。
