Park C S, Chung W M, Lim M K, Cho C H, Suh C H, Chung W K
Department of Radiology, Inha University Hospital, Songnam, Kyunggi-do, Korea.
AJR Am J Roentgenol. 1996 Sep;167(3):649-52. doi: 10.2214/ajr.167.3.8751672.
Our objective was to evaluate the usefulness of intracavitary instillation of urokinase in the treatment of loculated pleural effusion.
We analyzed CT and sonographic scans of 31 patients with loculated pleural effusion treated with intracavitary urokinase. When the drainage was less than 100 ml/day, urokinase was instilled through the catheter until the drainage was less than 50 ml/day. Response to the treatment was assessed on follow-up chest radiographs and classified into three groups: completely effective (lung expansion > 80%), partially effective (20-80%), and ineffective (< 20%). The sonographic pattern of pleural fluid was classified as anechoic, linear septated, or honeycomb, and the thickness of the parietal pleura was measured on CT scans.
Of the 16 patients in whom treatment was completely effective, sonography showed an anechoic appearance in 12 and a linear septated appearance in four, and the thickness of the parietal pleura on CT scans was 2 mm in six, 3 mm in seven, and 4 mm in three. Of the nine patients in whom treatment was partially effective, sonography showed an anechoic appearance in six and a linear septated appearance in three, and the thickness of the parietal pleura on CT scans was 3 mm in five and 4 mm in four. Of the six patients in whom treatment was ineffective, sonography showed a linear septated appearance in one and a honeycomb appearance in five, and the thickness of the parietal pleura on CT scans was 3 mm in one, 4 mm in two, 5 mm in one, and 6 mm in two.
Urokinase instillation through a percutaneous catheter was effective in the treatment of loculated pleural effusion in most patients but was not effective in patients whose pleural fluid had a honeycomb appearance on sonography or whose parietal pleura had a thickness of more than 5 mm on CT scans.
我们的目的是评估腔内注射尿激酶在治疗局限性胸腔积液中的有效性。
我们分析了31例接受腔内尿激酶治疗的局限性胸腔积液患者的CT和超声扫描结果。当引流量小于100毫升/天时，通过导管注入尿激酶，直至引流量小于50毫升/天。根据随访胸部X线片评估治疗反应，并分为三组：完全有效（肺扩张>80%）、部分有效（20%-80%）和无效（<20%）。胸腔积液的超声表现分为无回声、线状分隔或蜂窝状，并在CT扫描上测量壁层胸膜的厚度。
在16例治疗完全有效的患者中，超声显示12例为无回声表现，4例为线状分隔表现，CT扫描上壁层胸膜厚度6例为2毫米，7例为3毫米，3例为4毫米。在9例治疗部分有效的患者中，超声显示6例为无回声表现，3例为线状分隔表现，CT扫描上壁层胸膜厚度5例为3毫米，4例为4毫米。在6例治疗无效的患者中，超声显示1例为线状分隔表现，5例为蜂窝状表现，CT扫描上壁层胸膜厚度1例为3毫米，2例为4毫米，1例为5毫米，2例为6毫米。
经皮导管注入尿激酶对大多数局限性胸腔积液患者有效，但对超声显示胸腔积液呈蜂窝状或CT扫描显示壁层胸膜厚度超过5毫米的患者无效。
