Nishina Makoto, Iwazaki Masayuki, Koizumi Masahiro, Masuda Ryota, Kakuta Takatoshi, Endoh Masayuki, Fukagawa Masafumi, Takagi Atsushi
Department of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
Tokai J Exp Clin Med. 2011 Dec 20;36(4):91-4.
Peritoneal dialysis (PD) is an established renal replacement therapy for patients with end-stage renal disease (ESRD), and it is an effective mean of treatment for maintaining patients' residual renal function and their quality of life (QOL). However, acute hydrothorax is one of the complications of PD that can lead to discontinuation of PD and a switch to hemodialysis. We report a case of a 51-year-old woman with ESRD secondary to chronic glomerulonephritis who was placed on intermittent PD (IPD) and developed right-sided acute hydrothorax one month later. Scintigraphy with technetium-99 m macroaggregated human albumin (Tc-99 m MAA) revealed presence of a pleuroperitoneal communication, and treatment by autologous blood pleurodesis was performed twice. However, the treatment was ineffective, and two months after the onset of the hydrothorax, we performed video-assisted thoracoscopic surgery (VATS), using collagen fleece coated with fibrin glue to seal off the communication. The surgical procedure was followed by complete resolution of the hydrothorax. It was possible to resume the PD about one month postoperatively, and there has been no evidence ofrecurrence of the hydrothorax. VATS with collagen fleece was effective in treating acute hydrothorax secondary to a pleuroperitoneal communication that developed as a complication of PD.
腹膜透析（PD）是终末期肾病（ESRD）患者公认的肾脏替代治疗方法，是维持患者残余肾功能和生活质量（QOL）的有效治疗手段。然而，急性胸腔积液是PD的并发症之一，可导致PD中断并转而进行血液透析。我们报告一例51岁女性患者，因慢性肾小球肾炎继发ESRD，接受间歇性腹膜透析（IPD）治疗，1个月后出现右侧急性胸腔积液。用99m锝标记的人聚合白蛋白（Tc-99m MAA）进行闪烁扫描显示存在胸膜腹膜通道，并进行了两次自体血胸膜固定术治疗。然而，治疗无效，胸腔积液发生两个月后，我们进行了电视辅助胸腔镜手术（VATS），使用涂有纤维蛋白胶的胶原绒来封闭通道。手术后胸腔积液完全消退。术后约1个月可以恢复腹膜透析，且无胸腔积液复发的证据。VATS联合胶原绒对治疗因腹膜透析并发症导致的胸膜腹膜通道引起的急性胸腔积液有效。
