CAJ | 학술논문

腹膜透析（ PD）是终末期肾病患者常用的肾脏替代治疗方法之一，因其居家可自行管理、操作简便、节省医疗资源，适合在我国社区和偏远地区推广应用。并发胸腹瘘是PD少见的并发症，严重影响PD患者的透析质量及生存状况。本文报道了一例采用滑石粉胸膜固定术联合小剂量递增式PD治疗PD并发胸腹瘘并随访24个月的病例，通过回顾本例患者的临床诊疗经过，提示PD患者出现单侧不明原因的大量胸腔积液时需高度警惕并发胸腹瘘。复习相关文献，由于胸腹交通常在右侧，如果X线胸片或胸部CT检查显示存在右侧胸腔积液，强烈提示本病。诊断性胸腔穿刺亦有助于区分积液的性质。当怀疑有胸腹瘘时，可腹腔内给予美蓝，若胸腔积液中亦有美蓝即可确诊。通过腹腔注射99 Tcm 聚集清蛋白或99 Tcm 硫胶，抽取胸腔积液测定放射性，亦能确诊存在胸腔渗漏。近年来有报道电视胸腔镜手术（ VATS）也可作为诊断手段。诊断明确时，采用传统的滑石粉胸膜固定术联合小剂量递增式PD，不仅能减少再发胸腹瘘风险，还能使患者获得长期较好的生存质量。
복막투석（ PD）시종말기신병환자상용적신장체대치료방법지일，인기거가가자행관리、조작간편、절성의료자원，괄합재아국사구화편원지구추엄응용。병발흉복루시PD소견적병발증，엄중영향PD환자적투석질량급생존상황。본문보도료일례채용활석분흉막고정술연합소제량체증식PD치료PD병발흉복루병수방24개월적병례，통과회고본례환자적림상진료경과，제시PD환자출현단측불명원인적대량흉강적액시수고도경척병발흉복루。복습상관문헌，유우흉복교통상재우측，여과X선흉편혹흉부CT검사현시존재우측흉강적액，강렬제시본병。진단성흉강천자역유조우구분적액적성질。당부의유흉복루시，가복강내급여미람，약흉강적액중역유미람즉가학진。통과복강주사99 Tcm 취집청단백혹99 Tcm 류효，추취흉강적액측정방사성，역능학진존재흉강삼루。근년래유보도전시흉강경수술（ VATS）야가작위진단수단。진단명학시，채용전통적활석분흉막고정술연합소제량체증식PD，불부능감소재발흉복루풍험，환능사환자획득장기교호적생존질량。
Peritonealdialysis(PD)isoneofthecommonrenalreplacementtherapiesinpatientswithend-stagere-nal diseases. Because of its convenient home self management,simple operation saving medical resources,it is suitable for popu-larization and application in communities and remote areas. Thoracoabdominal fistula,a rare complication of PD,seriously affects dialysis quality and the survival status of PD patients. This paper reports a case of PD patients complicated with thoracoabdominal fistula who was treated with talc powder pleurodesis in combination with small dose of incremental PD and received 24 months' fol-low-up. By reviewing the clinical diagnosis and treatment,the report suggests that massive pleural effusion with unknown cause on one side might be a high alert with thoracoabdominal fistula. The chest and abdomen junction often on the right side,if the chest X-ray or chest computer tomography( CT)shows the presence of right pleural effusion,it is strongly suggestive of the dis-ease. Diagnostic thoracentesis also helps to distinguish effusion. After intraperitoneal administration of methylene blue,if the meth-ylene blue can be found in pleural effusion,thoracoabdominal fistula can be confirmed. Thoracic leakage can also be diagnosed by intraperitoneal injection of 99 Tcm albumin aggregated or 99 Tcm sulfur colloid and extracting pleural effusion to determine radioac-tive. In recent years it is reported on TV thoracoscope( VATS)can be used as a means of diagnosis. When a clear diagnosis is made,the traditional talc pleurodesis in combination with small dose of incremental PD can reduce the risk of recurrence of thora-coabdominal fistula,and make the patients get better and long-term survival quality.