Prager R L, Wilson C H, Bender H W
Ann Thorac Surg. 1982 Jul;34(1):6-9. doi: 10.1016/s0003-4975(10)60844-2.
During the 36-month period from July, 1978, through July, 1981, 25 patients underwent a subxiphoid pericardial window procedure for diagnosis and therapy. Twelve patients were operated on for uremic pericarditis, 6 for malignancy, and 7 for etiological diagnosis of the pericarditis. All 12 patients with renal failure had enlarging effusions, despite aggressive dialysis. Eleven of the 12 are alive, free from recurrence, 3 to 36 months postoperatively. Six patients were operated on for suspected pericardial malignancy with hemodynamic compromise. Histological diagnosis was made from the pericardial tissue in all patients; only 1 patient lived more than 43 days following the procedure. In the group of 7 patients operated on for diagnosis, 4 were thought preoperatively to have tuberculous pericarditis. All 4 were treated with anti-tuberculosis chemotherapy and are asymptomatic, without evidence of calcification, 12 to 31 months postoperatively. This diverse group of patients demonstrates that the subxiphoid pericardial window is an effective approach for relief of uremic effusions and may adequately treat effusive tuberculous pericarditis when combined with multidrug chemotherapy. Patients with suspected malignant pericardial disease and hemodynamic compromise need to be carefully studied before an operative procedure is considered as a means of diagnosis and therapy.
在1978年7月至1981年7月的36个月期间，25例患者接受了剑突下心包开窗术以进行诊断和治疗。12例患者因尿毒症性心包炎接受手术，6例因恶性肿瘤，7例因心包炎的病因诊断。所有12例肾衰竭患者尽管进行了积极透析，积液仍在增多。12例中有11例存活，术后3至36个月无复发。6例患者因疑似心包恶性肿瘤伴血流动力学障碍接受手术。所有患者均通过心包组织进行组织学诊断；术后只有1例患者存活超过43天。在7例接受诊断性手术的患者中，4例术前被认为患有结核性心包炎。所有4例均接受抗结核化疗，术后12至31个月无症状，无钙化证据。这群不同类型的患者表明，剑突下心包开窗术是缓解尿毒症性积液的有效方法，与多药化疗联合使用时可充分治疗渗出性结核性心包炎。对于疑似恶性心包疾病伴血流动力学障碍的患者，在考虑将手术作为诊断和治疗手段之前，需要仔细研究。
