心包开窗和经皮心包穿刺引流治疗心包积液的比较

Comparison of subxiphoid pericardiostomy with percutaneous catheter drainage for pericardial effusion

目的比较经皮心包穿刺和剑下心包开窗治疗有症状心包积液的结果。方法回顾性分析10年间分别接受经皮心包穿刺和剑下心包开窗手术治疗的心包积液患者的结果。结果160例患者因症状性心包积液接受治疗,其中106例为剑下心包开窗,54例为经皮心包穿刺。经皮心包穿刺组并发症发生率为2%,与心包开窗组的5%相近(P=0.64)。心包开窗组中10例(11%)心包积液复发,6例(6%)出现心包缩窄;而经皮穿刺组有12例(25%)复发,10例(21%)发生缩窄(P=0.01)。单纯心包积液细胞学对恶性疾病的确诊率为19%,低于心包积液联合心包活检的确诊率(45%),有显著性差异(P=0.02)。结论经皮心包穿刺和心包开窗同样有效而安全。心包开窗治疗后的复发率和心包缩窄发生率较低,而且能够通过心包活检提高恶性疾病的确诊率。

Objective To compare results of percutaneous catheter drainage and subxiphoid pericardiostomy for symptomatic pericardial effusion. Methods The study analyzes the outcomes of percutaneous catheter drainage or subxiphoid pericardiostomy for symptomatic pericardial effusions during 10 years. Results Symptomatic pericardial effusions in 160 patients were treated by percutaneous catheter drainage （n=54） or subxiphoid pericardiostomy （n=106）. Complications were similar in both groups （2% vs.5%, =0.64）. Effusion recurred in 25% patients of percutaneous group compared with 11% in the other group （P=0.03）. Constrictive pericarditis occurred more frequently in percutaneous group than in the operative group （7% vs. 21%, P=0.01 ）. The diagnosis of malignancy was confirmed in 19% of patients with known malignancy in percutaneous group, while cytology and pericardial biopsy revealed 45% of malignancy （P=0.02）. Conclusions Subxiphoid and percutaneous pericardial drainage of symptomatic pericardial effusions can be performed safely. Subxiphoid pericardiostomy with pericardial biopsy appears to decrease recurrence and constriction and improve diagnostic accuracy of malignancy over cytology alone.