经皮穿刺置管诊断治疗恶性心包积液34例临床分析

Clinical study on diagnosis and treatment of 34-patient with malignant pericardial effusion by percutaneous pericardiocentesis and transcatheter

摘要:

目的探讨经皮心包穿刺置管在恶性心包积液诊断和治疗方面的价值.方法治疗组用单腔中心静脉管对34例心包积液患者进行心包穿刺置管引流,并搜集标本进行细胞学和组织学检查,并给予心包内注药化疗.对照组14例合并心包积液的恶性肿瘤患者,只定期行心包穿刺减压和常规细胞学检查,不行心包腔内化疗.结果治疗组有11例患者在术前已找到肿瘤细胞,有17例第1次抽液找到肿瘤细胞,6例在第2次确诊,确诊率为100%;心包内化疗达到完全缓解(CR)者有12例,部分缓解(PR)18例,无效4例,总治疗有效率达88.2%.对照组第1次穿刺抽液确诊4例,第2、3、4次穿刺抽液确诊分别为2例、3例和1例,确诊率为71.43%;单纯抽液达CR者1例,PR者5例,无效8例,有效率达42.86%.结论经皮穿刺置管治疗恶性心包积液是一项非常有效的诊断和治疗方法.

Abstract:

Objective: To explore the value of diagnosis and treatment of percutaneous pericardiocentesis and transcatheter in malignant pericardial effusion. Methods: 34 patients (treatment group) with malignant pericardial effusion were drained through percutaneous pericardiocentesis and transcatheter with center vein catheter, these collected samples of cell and tissue were examined. 14 patients (control group)regularly were drained and examined samples of cells through pericardiocentesis. Results: Treatment group: Of all cases, tumor cells had found in 11 cases before operation, 17 patients were found tumor cells at the first drain, 6 at the second, and the diagnostic rate was 100%. Of all treated patients, complete remission was (CR) 12 cases; partial remission (PR) 18; no change (NC) 4; total response rates 88.2%. In control group, 4 patients were diagnosed in the first pericardiocentesis, 2 patients, 3 patients and 1 patient were diagnosed in the second, third and forth pericardiocentesis respectively,and the diagnostic rate was 71.43%. By single pericardiocentesis, CR was 1case; PR 5 cases; NC 8 cases. Total response rate was 42.86%. Conclusion: It is a much effective method of diagnosis and treatment to treat malignant pericardial effusion through peritaneous pericardiocentesis and transcatheter.