Stoliński Jarosław, Plicner Dariusz, Mędrzyński Michał, Kapelak Bogusław
Przegl Lek. 2017;74(3):106-9.
To report the efficacy of chronic pericardial effusion treatment with pericardial window creation through video-assisted thoracoscopic surgery and pericardial drainage through a small subxiphoid incision.
Retrospective analysis of 31 patients after pericardial window creation through video-assisted thoracoscopic surgery (PW group) and 77 patients where pericardial drainage through small subxiphoid incision (PD group) was performed. Echocardiography examinations were performed to document pericardial tamponade and pericardial effusion recurrence.
Length of surgery was 20.5±5.4 minutes in the PD group and 25.8±6.4 minutes in the PW group, p<0.001. Amount of fluid evacuated from pericardium during surgery was 483±191 ml and 521±253 ml in PD and PW groups respectively, p=0.654. Postoperative drainage was maintained longer (4.3±1.4 days vs. 3.2±1.0, p<0.001) and the amount of fluid drained after surgery was higher (497±351 ml vs. 309±231 ml, p=0.031) in the PW group. The amount of pericardial fluid at the end of hospitalization was statistically significantly higher in the PD group compared with the PW group (8.9±4.9 mm vs. 4.9±3.2 mm, p<0.001). Hospital stay was 5.7±2.7 days in the PD group and 6.1±3.4 in the PW group, p=0.112. No patient died during hospitalization period in either group. Mortality within 30 days after surgery was 2.6% in the PD and 3.2% in the PW group (p=0.642). In the PW group there were 4 conversions to right minithoracotomy due to dense pleural adhesions. Pericardial effusion recurrence occurred in 9 patients (12.0%) in the PD group and none was observed (0.0%) in the PW group (p=0.042) within 30 days after surgery.
Pericardial window creation through video-assisted thoracoscopic surgery should be considered the preferred method over pericardial drainage through a small subxiphoid incision for chronic pericardial effusion and pericardial tamponade treatment to reduce the frequency of pericardial effusion reoccurrence.
报告通过电视辅助胸腔镜手术创建心包开窗术及经剑突下小切口进行心包引流治疗慢性心包积液的疗效。
回顾性分析31例行电视辅助胸腔镜手术创建心包开窗术的患者（PW组）和77例行经剑突下小切口心包引流术的患者（PD组）。进行超声心动图检查以记录心包填塞和心包积液复发情况。
PD组手术时间为20.5±5.4分钟，PW组为25.8±6.4分钟，p<0.001。PD组和PW组手术期间心包排出的液体量分别为483±191毫升和521±253毫升，p=0.654。PW组术后引流维持时间更长（4.3±1.4天对3.2±1.0天，p<0.001），术后引流量更高（497±351毫升对309±231毫升，p=0.031）。与PW组相比，PD组住院末期心包液量在统计学上显著更高（8.9±4.9毫米对4.9±3.2毫米，p<0.001）。PD组住院时间为5.7±2.7天，PW组为6.1±3.4天，p=0.112。两组均无患者在住院期间死亡。PD组术后30天内死亡率为2.6%，PW组为3.2%（p=0.642）。PW组有4例因致密胸膜粘连转为右胸小切口手术。术后30天内，PD组有9例（12.0%）发生心包积液复发，PW组未观察到复发（0.0%）（p=0.042）。
对于慢性心包积液和心包填塞的治疗，与经剑突下小切口心包引流相比，应考虑将电视辅助胸腔镜手术创建心包开窗术作为首选方法，以降低心包积液复发频率。
Zotero 插件