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目的探讨持续非卧床性腹膜透析(CAPD)患者并发胸腹瘘的临床表现、诊断方法及治疗与转归。方法观察广州市番禺区中心医院2005年至2010年收治的3例CAPD并发胸腹瘘患者,对其临床表现、诊断方法及治疗与转归进行分析与总结。结果 3例患者均出现气促、胸闷、不能平卧,伴超滤量明显减少,影像学提示中-大量右侧胸腔积液;应用胸水生化成分分析鉴定胸水性质,同时以标记放射性核素99mTc-乙三胺五乙酸(DPTA)注入透析液后,在胸膜腔中探测到99mTc确诊;经抽取胸水、暂停CAPD、改行间隙性腹膜透析等治疗方法效欠佳,3例患者最终都转为血液透析治疗。结论从临床表现可早期发现胸腹瘘,用核素扫描结合胸水生化成分分析诊断胸腹瘘敏感性高,不良反应少。出现胸腹瘘后患者较难再维持腹膜透析治疗。
Objective To investigate the clinical manifestations, diagnosis, treatment and prognosis of patients with continuous non-ambulatory peritoneal dialysis (CAPD) complicated with pleural and abdominal fistula. Methods Three patients with CAPD complicated with thoracic and abdominal fistula admitted from 2005 to 2010 in Panyu Central Hospital of Guangzhou were enrolled. Their clinical manifestations, diagnosis, treatment and outcome were analyzed and summarized. Results All the 3 patients showed shortness of breath, tightness of the chest, no supine, significant reduction of ultrafiltration volume and large volume of right pleural effusion in imaging studies. The pleural effusion was identified by biochemical analysis of pleural effusion. The radioactive isotope labeled 99mTc - ethylenediaminetetraacetic acid (DPTA) into the dialysate, the detection of 99mTc in the pleural cavity was confirmed; after pleural effusion, pause in CAPD, intermittent peritoneal dialysis and other treatment ineffective, 3 patients eventually turned into blood Dialysis treatment. Conclusions Fetal and abdominal fistulas can be found early in clinical manifestations. The sensitivity of pleural and abdominal fistulas to be diagnosed by radionuclide scan combined with biochemical analysis of pleural effusion is high, with few adverse reactions. Patients with chest and fist after the more difficult to maintain peritoneal dialysis treatment.