经皮置管对恶性心包积液的诊断和治疗(附34例报告)

Percutaneous tubing and drainage for the diagnosis and treatment of malignant pericardial effusion

目的 对于恶性心包积液者 ,经皮一次心包穿刺置管达到急救、诊断和对因治疗。方法34例拟诊为恶性心包积液者 ,穿刺心包成功后 ,经针尾部置入外径 1.8mm引流管 ,以医用三通将引流管与引流袋连通。收集引流袋内积液中类似组织状的凝集块 ,按组织活检标本处理后光镜检查 ;同时送检积液细胞学。病因明确者 ,心包内注入抗癌药 4h后再开放引流 ,引流量连续 2天≤ 30ml/ 2 4h时拔管。结果 34例均一次置管成功 ,心包填塞症状于 15～ 6 0min解除。凝集块阳性率 91.2 % ,细胞病理分型确定率 10 0 % ;细胞学阳性率 6 1.8% ,细胞病理分型确定率 81.0 %。两种方法比较 ,差异均有显著性 (P <0 .0 0 5 ,P <0 .0 2 5 )。凝集块和细胞学两种方法相加阳性率 94.1%。 2 9例心包内注入抗癌药行局部化疗。 33例置管引流时间平均 6d。结论 此法是一种集急救、诊断、对因治疗为一体的心包置管引流方法 ;以积液凝集块细胞病理学作为病因诊断的手段 ,是一种无创、阳性检出率高的病理标本获取和检查方法。

Objective To insert a tube into pericardial cavity as an emergent measure of diagnosis and treatment in patients with malignant pericardial effusion.Methods Pericardial puncture was followed by insertion of drainage tube (diameter=1.8 mm) through the puncture needle. The effusion collected was examined for cancer cells. After drainage, chemotherapeutic agents were administered . Four hours later, drainage was continued for 2 days (≤30 ml pericardial fluid drained in 24 hr) and the tube was removed.Results In 34 cases with malignant pericardial effusion, tube draining was successful to relieve cardiac temponade within 15～60 minutes. Clots were present in 91.2% of the cases and cancer diagnosis was confirmed in all of them. The cytologic diagnosis of effusion was positive in 61.8%, and the cyto pathologic typing of clots was 81.0%. The difference was statistically significant. When the results of the 2 examinations were put together, the positive rate increased to 94.1%. Conclusion Tube drainage of malignant pericardial effusion is useful in diagnosis and emergency treatment.