Department of Diagnostic Radiology, Interventional Radiology Section, Unit 325, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Cardiovasc Intervent Radiol. 2009 Nov;32(6):1217-26. doi: 10.1007/s00270-009-9594-7. Epub 2009 May 27.
The purpose of this study was to report our clinical experience with image-guided drainage of pericardial effusions in oncology patients. IRB approval was obtained for this retrospective, HIPAA-compliant study. From November 2002 to January 2008, 40 patients underwent 43 image-guided drainages of pericardial effusions. The medical records were reviewed to analyze the technical aspects of the procedures, complications, and clinical outcomes. Thirty-three pericardial drains were placed and 10 pericardiocenteses were performed. The technical success rate was 100%. Thirty-three procedures were performed under computed tomographic (CT) guidance, five under ultrasound (US) guidance, and five using both CT and US guidance. There were no technical, procedure-related complications. Delayed postprocedure complications and arrhythmias occurred in 11 cases, for an overall complication rate of 25.6%. All complications occurred in patients who had undergone drain placement. Nine patients developed new or worsening arrhythmias and six of these patients required transfer to a higher level of care or the initiation of pharmacological management. In 58.6% of drain placements, including 4 of 11 patients who developed complications, the catheter could have been removed earlier. The median overall survival was 6.47 months (95% CI: 2.37, 12.7). In conclusion, image-guided pericardial drain placement is safe and feasible. Due to the frequency of delayed postprocedure arrhythmias, follow-up monitoring in a telemetry unit is recommended. Prompt catheter removal after drainage may reduce the incidence of delayed post-catheter-insertion arrhythmias.
本研究旨在报告我们在肿瘤患者中心包积液的影像引导引流的临床经验。本回顾性研究符合 HIPAA 规定，并获得了 IRB 批准。从 2002 年 11 月至 2008 年 1 月，40 名患者接受了 43 例心包积液的影像引导引流。对病历进行了回顾性分析，以分析手术的技术方面、并发症和临床结果。33 例心包引流，10 例心包穿刺。技术成功率为 100%。33 例在 CT 引导下进行，5 例在超声引导下进行，5 例同时在 CT 和超声引导下进行。无技术相关并发症。11 例发生迟发性术后并发症和心律失常，总并发症发生率为 25.6%。所有并发症均发生在接受引流的患者中。9 例患者出现新发或加重心律失常，其中 6 例需要转至更高水平的护理或开始药物治疗。在 58.6%的引流中（包括 11 例发生并发症的患者中的 4 例），可以更早地移除导管。总的中位生存时间为 6.47 个月（95%CI：2.37，12.7）。总之，影像引导心包引流是安全可行的。由于迟发性术后心律失常的发生率较高，建议在遥测单元进行随访监测。引流后及时拔除导管可能会减少迟发性导管插入后心律失常的发生。
