Department of Surgery, Northwestern University, Chicago, IL, USA.
Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St., Suite 650, Chicago, IL, 60611, USA.
Curr Cardiol Rep. 2018 Aug 20;20(10):92. doi: 10.1007/s11886-018-1040-5.
Pericardial effusion is commonly associated with malignancy. The goals of treatment should include optimizing symptom relief, minimizing repeat interventions, and restoring as much functional status as possible.
Pericardiocentesis should be the first intervention but has high recurrence rates (30-60%). For patients with recurrence, repeat pericardiocentesis is indicated in those with limited expected lifespans. Extended pericardial drainage decreases recurrence to 10-20%. The addition of sclerosing agents decreases recurrence slightly but creates significant pain and can lead to pericardial constriction and therefore has fallen out of favor. Most patients with symptomatic pericardial disease have a short median survival time due to their underlying disease. In patients with a longer life expectancy, surgical drainage offers the lowest recurrence rate. Surgical approach is based on effusion location and clinical condition. Subxiphoid and thoracoscopic approaches lead to similar outcomes. Thoracotomy should be avoided as it increases morbidity without improving outcomes.
心包积液常与恶性肿瘤相关。治疗目标应包括优化症状缓解，尽量减少重复干预，并尽可能恢复更多的功能状态。
心包穿刺术应作为首选治疗方法，但复发率较高（30-60%）。对于复发患者，预期寿命有限的患者需要再次心包穿刺。延长心包引流可将复发率降低至 10-20%。硬化剂的加入可略微降低复发率，但会引起明显疼痛，并可能导致心包缩窄，因此已不再受欢迎。大多数有症状的心包疾病患者由于其潜在疾病，中位生存时间较短。在预期寿命较长的患者中，手术引流的复发率最低。手术方法基于积液位置和临床情况。剑突下和胸腔镜方法的结果相似。开胸手术应避免，因为它会增加发病率，而不会改善预后。
