Geissbühler K, Leiser A, Fuhrer J, Ris H B
Department of Thoracic and Cardiovascular Surgery, Inselspital, University of Bern, Switzerland.
Eur J Cardiothorac Surg. 1998 Oct;14(4):403-8. doi: 10.1016/s1010-7940(98)00153-5.
The validity of video-assisted thoracoscopic pericardial fenestration was prospectively assessed for loculated effusions. effusions previously treated by percutaneous catheter manoeuvres and those with concurrent pleural diseases.
Inclusion criteria consisted of echocardiographically documented pericardial effusions requiring diagnosis or relief of symptoms and recurrent effusions after failed percutaneous drainage and balloon pericardiotomy. Pre-operative CT-scan was used to delineate additional pleural pathology and to determine the side of intervention. All patients were followed clinically and by echocardiographic examination 3 months post-operatively.
Twenty-four patients underwent thoracoscopic pericardial fenestration with 11 patients (54%) being previously treated by percutaneous catheter drainage, balloon pericardiotomy or subxyphoidal fenestration. Pre-operative echocardiography revealed septation and loculation in 18 patients (72%). Additional pleural pathology was identified on CT scan in 12 patients (50%) and talc pleurodesis was performed in six patients, all suffering from malignant pleural effusion. The mean operation time was 45 min (range 30-60 min) with no complications being observed. All patients were followed 3 months post-operatively by clinical and echocardiographic examination; relief of symptoms was achieved in all patients but echocardiography showed a recurrence in one patient (4%). Another recurrence was found by echocardiography after a mean follow-up time of 33 months in the 12 patients suffering from a non-malignant pericardial effusion. No recurrence of pleural or pericardial effusion was observed in the subset of patients with talc pleurodesis.
Video-assisted thoracoscopic pericardial fenestration is safe and effective for loculated pericardial effusions previously treated by percutaneous drainage manoeuvres and those with concomitant pleural disease.
前瞻性评估电视辅助胸腔镜心包开窗术治疗包裹性心包积液、既往经皮导管操作治疗的心包积液以及合并胸膜疾病的心包积液的有效性。
纳入标准包括经超声心动图证实需要诊断或缓解症状的心包积液，以及经皮引流和球囊心包切开术失败后的复发性心包积液。术前CT扫描用于明确额外的胸膜病变并确定干预侧。所有患者术后3个月进行临床随访和超声心动图检查。
24例患者接受了胸腔镜心包开窗术，其中11例（54%）既往接受过经皮导管引流、球囊心包切开术或剑突下心包开窗术。术前超声心动图显示18例患者（72%）存在分隔和包裹。12例患者（50%）的CT扫描发现了额外的胸膜病变，6例患有恶性胸腔积液的患者进行了滑石粉胸膜固定术。平均手术时间为45分钟（范围30 - 60分钟），未观察到并发症。所有患者术后3个月进行临床和超声心动图检查；所有患者症状均得到缓解，但超声心动图显示1例患者（4%）复发。在12例非恶性心包积液患者中，平均随访33个月后，超声心动图发现另一例复发。滑石粉胸膜固定术患者亚组未观察到胸膜或心包积液复发。
电视辅助胸腔镜心包开窗术对于既往经皮引流治疗的包裹性心包积液以及合并胸膜疾病的心包积液是安全有效的。
