Tsuchiya Takehiro, Sano Atsushi, Fukami Takeshi, Yanagi Mai, Yoshiura Tatsunori, Kobayashi Ryu
Department of Thoracic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan.
Kyobu Geka. 2014 Oct;67(11):963-6.
A 54-year-old female who was started on continuous ambulatory peritoneal dialysis( CAPD) for endstage renal disease secondary to focal developed 2 pleuroperitoneal communications. At first, she developed chest pain and cough on the day following introduction. A 99m-technetium-macroaggregated albumin (99mTc-MAA) radionuclide scan showed a communication between the abdomen and the right pleural cavity. We diagnosed a right pleuroperitoneal communication. Four months later, she developed similar symptoms and was diagnosed with a left pleuroperitoneal communication. Video-assisted thoracoscopic surgery was performed for each lesion. However, the communications were detected using different methods. During the 1st surgery, the communication was detected using peritoneal dialysis fluid containing indigocarmine introduced through a CAPD catheter. During the 2nd surgery, the communication was detected by pneumoperitoneum. With regards to diaphragmatic pressure regulation, pneumoperitoneum was more rapid and convenient, so pneumoperitoneum was considered more effective for the identification and treatment of pleuroperitoneal communications. Diaphragmatic plication and pleurodesis with polyglycolic acid felt and fibrin glue on both sides were performed. No recurrence of hydrothorax was detected after treatment.
一名54岁女性因局灶性终末期肾病开始持续非卧床腹膜透析（CAPD），继发出现2处胸膜腹膜交通。起初，在开始透析后的第二天她出现胸痛和咳嗽。锝-99m-大颗粒聚合白蛋白（99mTc-MAA）放射性核素扫描显示腹部与右胸腔之间存在交通。我们诊断为右胸膜腹膜交通。四个月后，她出现类似症状，被诊断为左胸膜腹膜交通。对每个病变均进行了电视辅助胸腔镜手术。然而，采用了不同方法检测到这些交通。在第一次手术中，通过CAPD导管注入含靛胭脂的腹膜透析液检测到交通。在第二次手术中，通过气腹检测到交通。关于膈肌压力调节，气腹更快速且方便，因此气腹被认为对胸膜腹膜交通的识别和治疗更有效。进行了双侧膈肌折叠术以及用聚乙醇酸补片和纤维蛋白胶进行胸膜固定术。治疗后未检测到胸腔积液复发。
