肿瘤性心包积液的介入性治疗

Treatment of Malignant Pericardial Effusion by Interventional Therapy

目的:阐明经剑突下穿刺猪尾导管心包引流并腔内化疗治疗恶性心包积液的有效性、安全性和实用性。方法:经剑突下心包穿刺置入猪尾导管于心包腔内间断引流。首次抽液量在500～600ml;24小时后抽液800～1000ml并腔内注射顺铂20mg;48小时抽完剩余积液再予以顺铂20mg腔内注射。引流间隙导管腔内灌注生理盐水,末端接一小三通并置于三不通状态。术后跟踪随访至患者死于原发病。结果:13例患者均为恶性心包积液。经治疗后心包积液消失8例;残余少量积液5例,但超声心动图随访发现积液无增多趋势。穿刺置管过程中无一例发生严重并发症。导管引流过程中,无一例出现导管滑脱、堵塞及心包腔内感染。随访发现无一例患者死于心包填塞。结论:经剑突下穿刺猪尾导管心包引流并腔内化疗治疗恶性心包积液可减轻恶性心包积液患者的痛苦,延长生命,是一有效、安全和实用的方法,值得临床推广使用。

Objective: To illustrate the treatment of malignant pericardial effusion by subxiphoid percutaneous pericardial pigtail catheter drainage and intrapericardial chemotherapy as a safe, effective and practical method. Methods: Pigtail catheter was advanced into the pericardial sac percutaneously at subxiphoid site and pericardial fluid was drained intermittently within 48 hours. 20mg of cispktin was injected into pericardial sac by pigtail catheter at 24 - hour and 48 - hour respectively. At the interval between drainage periods, the lumen of catheter was flushed by saline and a small tee connection was connected to the end of the pigtail catheter and in the state of all - off. Follow - up was done till the patient died of malignancy. Results: 13 patients with malignant pericardial effusion were treated in this way. After the treatment, pericardial effusion disappeared in 8 and remained small in the rest 5 but kept stable after echocardiographic follow -up. No complications happened during the procedure. No catheter dislocation .occlusion and pericardial infection were found. No patient died of pericardial temponade after follow- up. Conclusion: Subxiphoid percutaneous pericardial pigtail catheter drainage and intrapericaldial chemotherapy is a safe,effective and practical method. It can relieve the patient's sufferings and prolong their life expectance. It should be recommended as a common way to treat malignant pericardial effusion.