难治性恶性胸腔积液28例治疗体会

胸腔内置管引流后注射化疗药物或生物制剂是治疗胸腔积液的最常见方法。但此方法对于部分难治性胸腔积液患者，常产生包裹性胸腔积液，严重影响患者生活质量。本文就难治性恶性胸腔积液的治疗过程中如何避免包裹性积液形成的体会报告如下。     

胸腔积液

胞必佳胸膜固定术治疗难治性气胸；锌、铜、硒测定在良、恶性胸腔积液鉴别中的临床价值探讨。     

胸腔积液

一、文中首先强调了X线胸部水平位检查是诊断少量胸腔积液较可靠而准确的方法。二、初步提出胸腔积液的新的发展规律:这就是按其液量的逐渐增加,先以膈胸膜炎的形式出现→后转为膈→肋胸膜炎→再转为典型的肋胸膜炎。当趋向治愈时,则以相反的程序发展。     

难治性结核性胸腔积液中异烟肼浓度的检测和对比

目的检测难治性包裹性结核性胸腔积液中异烟肼的药物浓度。方法对口服异烟肼、异烟肼直接注入包裹性胸腔积液中,检测胸腔积液和血液中异烟肼的浓度。结果口服异烟肼后包裹性胸腔积液中异烟肼的浓度(0.29±0.34)远低于血液中异烟肼的浓度(3.04±1.75);异烟肼直接注入包裹性胸腔积液中异烟肼的浓度(1.62±0.95)远高于血液中异烟肼的浓度(0.25±0.17),以后随注药次数增加,胸腔积液内异烟肼浓度越来越高(3.97±0.94,8.11±2.4),血液中异烟肼浓度无显著增加(0.21±0.26,0.32±0.14)。结论异烟肼直接注入包裹性胸腔积液能明显提高胸腔积液内的药物浓度,是治疗难治性结核性胸腔积液的有效手段。     

胸腔镜辅助胸腔清理术治疗难治性结核性胸腔积液的疗效及安全性观察

局麻下用胸腔镜辅助胸腔清理术治疗难治性结核性胸腔积液25例,配合全身抗结核治疗及每周2～3次的胸腔内注药局部治疗3～7d,胸腔积液消失,拔管后未再复发。术后1个月治愈19例。随访1a,治愈率100%。认为胸腔镜辅助胸腔清理术治疗难治性结核性胸腔积液效果好、安全,并发症少。     

恶性胸腔积液

恶性胸腔积液可分原发性和继发性两种。前者由胸膜本身的恶性肿瘤引起,后者由邻近脏器恶性肿瘤的侵袭及远处器官恶性肿瘤的胸膜转移所引起。原发性者较少见,其组织学差异较大,且模糊、不易分清,大致可分为四型:①腺管乳头状型,②肉瘤型,③未分化多边细胞型,④混合型。目前认为本病与接触石棉类物质和橄榄石有关。继发性者多见,几乎所有恶性肿瘤(除颅脑肿瘤外)都可并发胸膜腔积液。常见的为肺癌及乳腺癌(约半数可并发胸腔积液),其次卵巢癌及淋巴瘤亦可见于肾、骨、胰、胃肠及泌尿系等恶性肿瘤。(一)临床表现:我们在临床上所见恶性胸腔积液多不发热,常有轻度干咳,胸闷、胸部隐痛不适、     

改良胸腔积液引流方法治疗恶性胸腔积液

我院内科自2005年始采用改良胸腔积液引流方法治疗恶性胸腔积液病人，获得良好疗效。     

心源性胸腔积液

心脏疾患并发胸水最常见的原因是充血性心力衰竭,其发生机制与心脏衰竭引起的皮下水肿相同。但因为胸水内的蛋白质含量(2～3克%)明显高于皮下水肿液内的蛋白质含量(0.2～0.5克%),所以有人认为胸膜毛细血管渗透压的增高对胸腔积液的产生有更重要的意义。尽管如此,临床所见到的心脏衰竭并发胸水远比心脏衰竭伴下肢水肿为少见,其原因可能与胸膜的静脉血液同时回流入体循     

酷似恶性胸腔积液的炎性胸腔积液一例

1病例简介 1.1现病史患者男性,76岁,汉族,已婚,工人,主因胸痛半月于2011-02-17日入院。缘于入院前半个月,患者出现右侧胸部疼痛,以咳嗽、深呼吸及活动后为著,伴右侧背部疼痛,伴咳嗽、咳白色黏痰,伴进食差及消瘦,无发热,无咯血,无恶心、呕吐,遂就诊于当地县级医院,     

The undiagnosed pleural effusion

The most common causes for undiagnosed transudative effusions are congestive heart failure and hepatic hydrothorax. Pleural fluid N terminal pro-brain natriuretic peptide levels higher than 1500 pg/mL are virtually diagnostic of congestive heart failure. The most common causes for undiagnosed exudative pleural effusions are malignancy, pulmonary embolism, and tuberculosis. Clinical characteristics of patients with a malignant pleural effusion are symptoms for more than 1 month, absence of fever, blood-tinged pleural fluid, and CT findings suggestive of malignancy. Thoracoscopy is useful to establish the diagnosis of malignancy and tuberculosis.     

胸腔积液生物标志物对结核性和恶性胸腔积液的鉴别价值

胸腔积液是一种常见的胸部疾病或并发症,可因多种疾病状态所致。病因上,可为原发胸膜的疾病,也可继发于心、肝、肾、肺、纵隔、脾、卵巢、结缔组织病以及血液系统等疾病;疾病类型包括肿瘤、感染性疾病、器官功能障碍和全身性疾病等,其中心力衰竭、恶性肿瘤、肺炎和结核所致胸腔积液占所有病例的3/4。根据Light标准,胸腔积液可分为渗出性和漏出性胸腔积液(分别简称为渗出液和漏出液)。漏出液患者多存在全身严重基础疾病,如充血性心力衰竭、肝硬化、肾病综合征、心包疾病等;渗出液的病因则更为复杂,以结核性胸腔积液(tuberculous pleural effusion,TPE)和恶性胸腔积液(malignant pleural effusion,MPE)最为常见。     

包裹性胸腔积液的治疗进展

包裹性胸腔积液作为顽固性胸腔积液的一种,多见于感染性疾病,通常胸腔穿刺难以完全抽取胸腔内积液,且无法对增厚的胸膜进行干预.随着对包裹性积液的深入研究,人们对其病理生理、发生机制有了更深刻的认识.现认为胸腔积液中纤维蛋白的沉积造成了包裹,并且导致胸膜增厚、黏连,胸廓畸形,最终影响肺功能.因此,在治疗基础疾病的基础上尽早充分引流胸腔积液,防止纤维蛋白沉积是预防包裹性胸腔积液的重要措施,而破坏已形成的小房、溶解胸腔内纤维蛋白网则是治疗的重要方法.目前,临床有较多的防治方法,本文综述近年来国内外在治疗方面的研究工作,介绍各种方法及药物在治疗中的作用及存在的不足.     

Lupus refractory pleural effusion: transient response to intravenous immunoglobulins.

A patient with systemic lupus erythematosus complicated by refractory bilateral pleural effusions is described. High dose corticosteroids with azathioprine, as well as intrapleural instillation of corticosteroids, proved ineffective in management. As our patient remained severely symptomatic and required repeated thoracocentesis, a therapeutic trial of intravenous immunoglobulins (IVIG) was attempted. IVIG had a beneficial effect, although of a transient and partial nature. Despite the results achieved, it seems that IVIG has limited value in treating lupus pleural effusion.     

A case of refractory bilateral pleural effusion due to post-irradiation constrictive pericarditis

A 51-year-old woman suffering from dyspnoea and refractory bilateral pleural effusions is discussed. The effusion was characterized as a transudate and cardiac decompensation and renal insufficiency were initially suspected. Diuretic agents were not effective and the patient required bilateral chest water-sealed drainage tubes for 4 months, after exclusion of neoplastic infiltration, collagen disease and other cardiac disorders. On echocardiogram, cardiac function and other findings were almost normal, except for shortening of deceleration time in transmitral flow velocity. To evaluate the reduced diastolic compliance, cardiac catheterization was performed, and revealed an elevated pressure in the right ventricle with a dip-and-plateau pattern, and constrictive pericarditis was diagnosed. The hydrothorax resolved after pericardiectomy and symptoms were alleviated. Three and a half years after surgery, the patient is well and taking only oral diuretics. The underlying mechanism of cardiac disorder appears to have been mixed restriction and constriction due to irradiation of her chest for breast cancer 13 years ago. Because the echocardiogram was within normal limits, the diagnosis was delayed. Radiation-induced constrictive pericarditis should be considered if there is an unexplained transudate effusion with a normal echocardiogram.     

血清及胸腔积液抗PPD-IgG检测对结核性胸腔积液的诊断价值

目的　评价血清、胸腔积液抗PPD-IgG检测对结核性胸腔积液的诊断价值。方法 采用酶联免疫吸附法(ELISA)检测58例结核性胸腔积液的血清、胸腔积液抗PPDIgG,同时与胸膜活检及胸腔积液抗酸杆菌阳性率作比较,并随机选择42例非结核性胸腔积液作为对照组。结果 结核性胸腔积液血清、胸腔积液抗PPD-IgG阳性率(82.8%,96.6%)与胸膜活检阳性率(56.9%),胸腔积液抗酸杆菌阳性率(0%)比较,有显著性差异(P<0.005)。与对照组血清、胸腔积液抗PPDIgG阳性率(11.9%,21.4%)比较,有显著性差异(P<0.005)。本法血清抗PPD-IgG敏感性为82.8%,特异性为88.1%,准确性为85.0%。胸腔积液抗PPD-IgG敏感性为96.6%,特异性为78.6%,准确性为89.0%。结论 同时检测血清、胸腔积液抗PPDIgG可作为诊断结核性胸腔积液的一种可行的辅助方法。