摘要
目的总结腹膜透析(peritoneal dialysis,PD)并发胸腹瘘的临床特点、诊断及鉴别诊断,探讨其发病原因及治疗方法。方法分析武汉市第四医院收治1例PD并发胸腹瘘患者的临床表现、胸腹水常规及生化、胸部CT、核素显像结果,总结其临床表现、诊断方法及处理方法。结果患者为女性,在行PD治疗4个月时发生右侧胸腹瘘,急性起病,表现为胸闷、喘气、咳嗽等限制性通气功能障碍。胸腔彩超及胸部CT提示右侧胸腔中等量积液,胸水常规提示无恶性细胞,胸水生化提示低蛋白、葡萄糖浓度升高,胸腹瘘核素显像提示右侧胸腔放射性分布浓聚,经胸腔穿刺引流,调整间歇性腹膜透析(intermittent peritoneal dialysis,IPD)方案等治疗后,患者转为血液透析(hemodialysis,HD),患者胸水明显减少,未再出现胸腹瘘等并发症。PD并发胸腹瘘并不多见,但一旦发生,应选择合适的处理方法,最大程度避免心肺功能损伤甚至危及生命的情况出现。结论PD并发胸腹瘘的可能性较小,多发生在PD的第一年,多见于女性,以右侧多见,通常是由于胸腔腹腔压力差导致的,诊断方法较多,可选择手术或者非手术治疗,但大多数患者最终都会转为HD。
Objective To discuss the causes and developments in treatment for peritoneal dialysis(PD)complicated with thoracoabdominal fistula,as well as its clinical symptoms,diagnosis,and differential diagnosis.Methods Clinical manifestations,routine and biochemical data from thoracoabdominal fluid,chest CT results,and radionuclide imaging results of a PD patient with a thoracoabdominal fistula admitted to Wuhan Fourth Hospital were examined,and the clinical manifestations,diagnosis,and treatment approaches were summarized.Results After receiving PD treatment for four months,the patient,a female,experienced an acute onset right thoracoabdominal fistula as well as symptoms of restrictive ventilation dysfunction such as chest tightness,panting,and coughing.While routine pleural fluid revealed no malignant cells,biochemical pleural fluid revealed low protein and elevated glucose concentration,and thoracoabdominal fistula radionuclide imaging revealed concentrated radiation distribution in the right thoracic cavity,the right thoracic cavity was equally filled with fluid according to color Doppler ultrasound and chest CT.The patient underwent thoracic puncture drainage,intermittent peritoneal dialysis(IPD)protocol correction,and conversion to hemodialysis(HD).Pleural fluid in the patient was significantly reduced,and problems such as a thoracoabdominal fistula never recurred.Although PD complicated with a thoracoabdominal fistula is uncommon,once it does,the best course of action should be taken to prevent damage to the cardiopulmonary system or perhaps a life-threatening condition.Conclusion PD is unlikely to be complicated with thoracoabdominal fistula,which mainly occurs within the first year of PD,is more common in women,and is more prevalent on the right side,often due to the difference in thoracoabdominal pressure.Various diagnostic methods are available,and surgical or nonsurgical treatment can be chosen,but most patients ultimately require HD.
作者
魏祖容
位红兰
任伟荣
董骏武
WEI Zurong;WEI Honglan;REN Weirong;DONG Junwu(School of Medicine,Jianghan University,Wuhan 430056,Hubei,China;Department of Nephrology,Wuhan Fourth Hospital,Wuhan 430030,Hubei,China)
出处
《江汉大学学报（自然科学版）》
2024年第6期70-76,共7页
Journal of Jianghan University：Natural Science Edition
关键词
腹膜透析
胸腹瘘
血液透析
并发症
治疗
peritoneal dialysis
thoracoabdominal fistula
hemodialysis
complications
treatment
