心包切除治疗小儿渗出性心包炎

Treatment of effusive pericarditis in children by pericardiectomy

目的 探讨渗出性心包炎的病因诊断及心包切除指征。方法 17例均行心包切除术。11例术前诊断与术后病理诊断一致,其中化脓性心包炎8例,结核性心包炎1例,放射性心包炎2例;术前诊断特发性心包炎6例中,术后病理诊断4例为结核性,余2例为非特异性炎症。结果 2例术中心跳缓慢、无力,经治疗恢复,无术后并发症。随访1～10年,病儿心功能良好。结论 结核性心包炎、病毒性心包炎病因诊断困难,心包切除除其治疗作用外,还有诊断价值。对渗出性心包炎内科治疗效果不好者应及时行心包切除术,以解除心包填塞及预防心包缩窄,同时也切除了病灶。

Objective To review aetiological diagnosis and operative indications of effusive pericarditis in children. Methods 17 patients with effusive pericarditis underwent pericardiectomy. The postoperative pathologic diagnosis in 11 cases was similar to preoperative diagnosis,8 purulent pericarditis,1 tuberculous pericarditis,2 radio pericarditis. 4 cases of 6 iliopathic pericarditis were proved to be tuberculous pericarditis and 2 cases no specificity inflammation after operation. Results In 2 patients heart rate and contraction force reduce during operation, then the patients recovered through treatment. No postoperative complications occurred. The cardiac function in all cases were normal through follow-up.Conclusion The aetiological diagnosis of tuberculous pericarditis and viral pericarditis is difficult. Pericardiectomy should be performed if medical treatment can not cure the patients. Pericardiectomy has not only treatment effect,but also diagnosticvalue.