超声心动图监测经皮介入诊断治疗心包积液

Percutaneous Pericardial Interventions for Diagnosls and Treatment of Pericardial Effusion Under Echocardiographic Guidance

目的：原因不明心包积液是临床诊断治疗的难题。本文旨在探讨超声心动图监测下经皮心包多部位活检、引流、灌洗诊断治疗此病的效果。方法：８０例病人在超声心动图监测下经皮穿刺用塞林格技术放入止血鞘，通过鞘内用活检镜行多部位心包活检。标本经病理常规及免疫组化（Ｋｅｒａｔｉｎ法）在光镜及电镜下检查经病因学包括多聚酶链反应（ＰＣＲ）查出病因。经鞘内用猪尾导管引流出所有积液，进行３～１４天病因灌洗治疗，然后拔出导管。结果：病因诊断率达８６％以上，经３～６个月随访，治愈率达９０％，无明显并发症发生。结论：新方法将介入技术应用于心包积液，集诊断、治疗于一体，较以往心包穿刺等方法有明显优越性。此法安全，适用于各级医院推广应用，国内外尚无同类方法报道。

Objective:Diagnosis and treatment of pericardial effusion of unknown etilolgy is a difficult problem in clinical practice. It was aimed to investigate the feasibility of percutaneous catheter-based pericardial multiple biopsy for the diagnosis, drainage and lavage for the treatment of this disease entity. Methods:Under Ultrasonic Cardiography guidance percutaneous pericardial puncture was completed then the hemostasis sheath was placed by Seldingers technique, and through the sheath multiple biopsies of the pericardium were taken. The samples were examined under light microscope and some under electron microscope, and polymerase chain reaction was used for etiologic diagnosis. A pigtail catheter was used to drain off all of the effusion. According to the pathologic reports, drugs of etiologic treatment were given through indwellng catheter for 3-14 days, then the cathter was withdrawn. Results: Etiologic diagnosis rate was around 86%, and in a follow up of 3-6 months the cure rate was 90%. No significant complication was found in all of the patients. Conclusion:This is the first report in the literature on using this treatment for pericardial effusion and it is superior to conventional pericardial puncture. It is safe and can be used in any hospital.