腹膜透析并发胸腹瘘临床观察

Clinical survey on three CAPD cases complicated with chest-abdominal fistula

目的探讨持续非卧床性腹膜透析(CAPD)患者并发胸腹瘘的临床表现、诊断方法及治疗与转归。方法观察广州市番禺区中心医院2005年至2010年收治的3例CAPD并发胸腹瘘患者,对其临床表现、诊断方法及治疗与转归进行分析与总结。结果 3例患者均出现气促、胸闷、不能平卧,伴超滤量明显减少,影像学提示中-大量右侧胸腔积液;应用胸水生化成分分析鉴定胸水性质,同时以标记放射性核素99mTc-乙三胺五乙酸(DPTA)注入透析液后,在胸膜腔中探测到99mTc确诊;经抽取胸水、暂停CAPD、改行间隙性腹膜透析等治疗方法效欠佳,3例患者最终都转为血液透析治疗。结论从临床表现可早期发现胸腹瘘,用核素扫描结合胸水生化成分分析诊断胸腹瘘敏感性高,不良反应少。出现胸腹瘘后患者较难再维持腹膜透析治疗。

Objective To investigate the clinical manifestations,diagnostic methods,therapy and turnover of the thoracic and abdominal fistula in continuous ambulatory peritoneal dialysis（CAPD） patients.Methods We observed three CAPD cases complicated with chest-abdominal fistula who were admitted between 2005 and 2010,and ananysed and summarized their clinical manifestations,diagnostic methods,therapies and turnovers.Results All the three cases had breathlessness,chest distress,and could not lie down,with obviously less ultrafiltrate quality.Chest radiograph of these three cases showed there were medium to massive pleural effusion in the right pectoral cavity.Pleural fluid biochemistry component analysis was used to identify the pleural fluid,and diethylene triaminepentaacetic acid marked 99mTc（99mTc-DPTA） was infused in the dialysates.The three cases were diagnosed by detecting 99mTc-DPTA in cavitas pleuralis.Therapies of draw pleural fliud,using intermittent peritoneal dialysis（IPD） instead of CAPD were disappointed,and the three cases resorted to hematodialysis finally.Conclusion Chest-abdominal fistula can be found early by clinical manifestations,radioisotope scanning combined with biochemistry component analysis has high sensitivity to diagnose chest-abdominal fistula,with less side-effect.Patients with chest-abdominal fistula always can not continue peritoneal dialysis.