Pathogenesis and management of hydrothorax complicating peritoneal dialysis
Pathogenesis and management of hydrothorax complicating peritoneal dialysis
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DOI：
10.1097/01.mcp.0000127901.60693.d0
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发表时间：
2004-07-01
影响因子：
3.3
通讯作者：
Chow, KM
中科院分区：
文献类型：
--
作者：
Szeto, CC;Chow, KM
回顾目的持续性非卧床腹膜透析（CAPD）并发胸腔积液约占所有患者的2%。微创手术的最新进展彻底改变了这种情况的治疗策略。胸腔穿刺术和胸水生化分析是一线调查。在不确定的情况下，或当临床需要证明交通的解剖结构时，需要采用成像方法，如腹膜造影。如果并发症的诊断得到证实，则需要停止腹膜透析。对于一半的病例，保守的方法允许重新开始CAPD，可能是因为泄漏的自发解决。对于儿童来说，小容量交换是一种可行的选择。在保守治疗失败的患者中，视频辅助胸腔镜胸膜固定术或胸膜修复术或两者都允许他们中的大多数继续进行CAPD。化学胸膜固定术可能适用于那些在没有视频辅助胸腔镜支持的中心保守治疗失败的患者。目前，只有少数患者将需要开放thoracotomy.SummaryOnce胸水继发于胸膜-腹膜通信被证实在CAPD患者，暂时停止腹膜透析仍然是一线治疗。目前的证据表明，电视胸腔镜胸膜固定术或修复术应该是保守治疗失败的患者的治疗选择。
Purpose of reviewHydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) appears in approximately 2% of all patients. Recent advances in minimally invasive surgery have revolutionized the treatment strategy of this condition.Recent findingsHydrothorax in CAPD is most commonly secondary to a pleuro-peritoneal communication. Thoracocentesis with biochemical analysis of pleural fluid is the first-line investigation. In uncertain cases, or when there is a clinical need to demonstrate the anatomy of the communication, an imaging approach such as peritoneal scintigraphy is required. Cessation of peritoneal dialysis is indicated if diagnosis of the complication is confirmed. For half of the cases, a conservative approach allows reinstitution of CAPD, presumably because of spontaneous resolution of the leakage. A small-volume exchange is a feasible alternative for children. In patients who failed conservative treatment, video-assisted thoracoscopic pleurodesis or diaphragmatic repair or both allows most of them to continue with CAPD. Chemical pleurodesis is probably indicated for those who failed conservative treatment in centers without video-assisted thoracoscopic support. Currently, only a minority of patients will require open thoracotomy.SummaryOnce hydrothorax secondary to pleuro-peritoneal communication is confirmed in CAPD patients, temporary cessation of peritoneal dialysis remains the first-line treatment. Current evidence shows that video-assisted thoracoscopic pleurodesis or repair should be the treatment of choice in patients who failed conservative management.