核素显像诊断持续性不卧床腹膜透析所致腹腔渗漏

目的 探讨高锝酸盐与透析液混合滴注腹腔核素显像对持续性不卧床腹膜透析(CAPD)患者可疑腹腔渗漏的诊断价值.资料与方法 14例肾功能衰竭患者行持续性不卧床腹膜透析后出现腹股沟、生殖器水肿(6例)或胸腔积液(8例),将锝液与透析液混合后腹腔滴注,行核素动态及延迟显像,观察腹腔渗漏情况.结果 胸腔积液组中6例显像1～2h内胸部观察到异常放射性出现,证实腹膜横膈漏的存在；2例患者经延迟和侧卧后诊断明确.确诊后1例行肾移植术,1例行横膈膜修补术.6例患者调整了透析方案,胸腔积液减少或消失.腹股沟、生殖器水肿组中5例显像后腹股沟或生殖器部位出现异常放射性浓聚,明确渗漏诊断；1例患者延迟至6h,未见明确渗漏表现.2例行鞘膜修补手术,4例改为间断性或血液透析治疗,腹股沟及生殖器部位水肿明显减少或消失.结论 对于大多数透析液腹腔渗漏患者,高锝酸盐核素显像可以达到满意的效果,为临床明确诊断及调整治疗方案提供依据.

Diagnosis of Peritoneal Leaks in Peritoneal Dialysis Using Tc-99m Pertechnetate Scintigraphy

Purpose To illustrate usefulness of Technetium-99m pertechnetate peritoneal scintigraphy in patients undergoing CAPD with suspected leakage of dialysate fluid from the peritoneal cavity.Materials and Methods Fourteen patients with complaints of genital and/or inguinal edema or pleural effusion during CAPD were referred for peritoneal scintigraphy to look for peritoneal leaks.After mixing Tc-99m Pertechnetate in peritoneal dialysis solution and administering into the peritoneal cavity,dynamic and delayed images were acquired to monitor the distribution of the fluid.Results Patients were divided into two groups.Group 1 included 8 patients with pleural effusion.Abnormal uptake was shown in the chest within 1-2 hours in six patients,confirming the presence of peritoneal diaphragmatic leakage.Two cases were diagnosed with the delayed images and lateral views.In 2 of the eight patients,renal transplantation and diaphragm repair surgery were performed.Pleural effusion decreased or disappeared in another six patients after modifying the dialysis solution or switch to hemodialysis.Group 2 included 6 patients with groin and/or perineal edema.Five patients showed intense activity accumulation extending to the groin or genital area consisting with dialysate leakage.No obvious abnormal accumulation of radiotracer was observed in the genital area in 6-hour images in one patient.After hydrocele repair surgery in two cases and four patients changed to intermittent or hemodialysis treatment,groin and genital edema were significantly reduced or disappeared.Conclusion Nuclear peritoneal scintigraphy using Tc-99m Pertechnetate can be employed successfully to demonstrate the peritoneal leaks,and help clinicians decide therapeutic approaches.