Green A, Logan M, Medawar W, McGrath F, Keeling F, Carmody M, Donohoe J
Department of Nephrology, Beaumont Hospital, Dublin, Ireland.
Perit Dial Int. 1990;10(4):271-4.
Four patients on continuous ambulatory peritoneal dialysis (CAPD) developed large, symptomatic pleural effusions after commencing peritoneal dialysis. Pleuroperitoneal fistula in each case was diagnosed by the presence of a high glucose content in pleural fluid, with a normal corresponding blood sugar, and was confirmed by isotope or contrast peritoneography. Two patients had their effusions drained percutaneously, and then underwent pleural sclerosis with intracavitary tetracycline. Two patients had a thoracotomy performed, of which no fistula was identified in one case, and the other patient underwent pleurectomy. All four patients successfully recommenced CAPD several weeks after therapy, without recurrence of effusions. We conclude that pleuroperitoneal connections associated with CAPD do not mandate cessation of peritoneal dialysis and conversion to maintenance haemodialysis. Definitive diagnosis requires aspiration of pleural effusions for glucose estimation. Contrast or isotopic peritoneography is helpful in localising the fistula, but in our experience did not alter management. Simple sclerotherapy is effective and avoids the need for a formal thoracotomy.
4例持续性非卧床腹膜透析（CAPD）患者在开始腹膜透析后出现大量有症状的胸腔积液。每例患者均通过胸腔积液中高葡萄糖含量且相应血糖正常诊断为胸膜腹膜瘘，并经同位素或造影剂腹膜造影证实。2例患者经皮引流胸腔积液，然后行胸腔内注入四环素胸膜固定术。2例患者接受了开胸手术，其中1例未发现瘘管，另1例患者接受了胸膜切除术。所有4例患者在治疗数周后均成功重新开始CAPD，胸腔积液未复发。我们得出结论，与CAPD相关的胸膜腹膜连接并不一定需要停止腹膜透析并转为维持性血液透析。明确诊断需要抽取胸腔积液进行葡萄糖测定。造影剂或同位素腹膜造影有助于瘘管定位，但根据我们的经验，这对治疗方案没有影响。简单的硬化疗法有效，避免了进行正式开胸手术的必要。
