恶性心包积液的手术引流治疗

目的：选择适当的手术方法治疗恶性心包积液。方法：对经剑突下小切口或左前外侧切口开胸行心包开窗引流术的24例恶性肿瘤合并心包积液的患者进行临床回顾性分析。结果：24例患者中，术后确诊19例，均为血性。术后全组患者呼吸困难、胸疼等症状有显著好转，无手术死亡。引流时间为3～16d，平均5．2d。心胸比值从术前平均0．65减少为平均0．43。术后3个月时，2例经剑突下切口途径患者因心包积液复发而再次手术开窗引流。而经左前外侧切口途径患者有1例胸腔内有中等量积液，行2～3次胸穿后积液消失。术后有6例出现循环血量不足的表现。结论：对于恶性心包积液有明显的血液动力学障碍，尤其是怀疑心包腔内有粘连者，可以根据具体情况选则这两种手术方式治疗。

Drainage of malignant pericardial effusion with operative method

Objective To choose an effective surgical procedure for patients with malignant pericardial effusion.Method The clinical data of 24 cases of malignant pericardial effusion drained with subxiphoid minimal incision or left anterior outboard incision during September 1996 to December 2006 was analyzed retrospectively.Results 19 cases were final diagnosed after operation and the effusions all contained blood.The symptoms of dyspnea and chest pain were improved remarkably following the drainage,no death occured.The drainage time kept for 3～16 days(average 5.2 days).The preoperative and postoperative mean cardiothoracic ratio in chest X-ray was 0.65 and 0.43,respectively.Two cases underwent subxiphoid minimal incision reoperated 3 months later because of recurrence.One case underwent left anterior outboard incision appeared pleural effusion of middle volume and was cured with 2～3 thorax puncture drainage.Insufficient circulating blood volume was found in 6 cases.Conclusion The above two methods were effective and selective for pericardial effusion according to concrete situations.