CAJ | 학술논문

目的：探讨腹膜透析患者并发胸腹瘘的临床表现、诊断方法及治疗与转归。方法对2011年1月—2014年12月收治的腹膜透析并发胸腹瘘患者5例的临床表现、诊断方法及治疗与转归进行分析。结果5例患者均出现胸闷、气促；影像学检查提示中～大量右侧胸腔积液；胸水透明清亮，蛋白定性试验阴性，胸水蛋白定量＜25 g／L，葡萄糖＞40 mmol／L，美蓝试验阳性，DPTA试验阳性。确诊后经抽取胸水、暂停持续非卧床腹膜透析，其中4例患者最终转为血液透析治疗，1例改为间歇性腹膜透析，瘘口愈合后再行维持性腹膜透析。结论胸腹瘘有胸腔负压消失的临床特点，用美蓝试验及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。出现胸腹瘘后患者大多转为维持性血液透析，较难再维持腹膜透析治疗。
목적：탐토복막투석환자병발흉복루적림상표현、진단방법급치료여전귀。방법대2011년1월—2014년12월수치적복막투석병발흉복루환자5례적림상표현、진단방법급치료여전귀진행분석。결과5례환자균출현흉민、기촉；영상학검사제시중～대량우측흉강적액；흉수투명청량，단백정성시험음성，흉수단백정량＜25 g／L，포도당＞40 mmol／L，미람시험양성，DPTA시험양성。학진후경추취흉수、잠정지속비와상복막투석，기중4례환자최종전위혈액투석치료，1례개위간헐성복막투석，루구유합후재행유지성복막투석。결론흉복루유흉강부압소실적림상특점，용미람시험급핵소소묘결합흉수생화성분분석진단흉복루민감성고，불량반응소。출현흉복루후환자대다전위유지성혈액투석，교난재유지복막투석치료。
Objective To investigate the clinical manifestations , diagnostic methods and treatment of peritoneal dial-ysis patients with thoracoabdominal fistula .Methods From 2011 January to 2014 December, 5 patients with peritoneal dialy-sis complicated with thoracic abdominal fistula were enrolled , the clinical manifestations , diagnostic methods and treatment and prognosis of them was analyzed .Results These 5 patients had chest tightness , shortness of breath; imaging revealed a medium to large amount of right pleural effusion; pleural effusion is transparent and clear , protein qualitative test was nega-tive, pleural effusion protein quantitative <25 g/L, glucose >40 mmol/L, methylene blue test is positive , DPTA test re-vealed positive result .After the diagnosis , by pleural effusion drainage , suspended extraction of continuous ambulatory perito-neal dialysis ,4 cases of patients eventually changed to hemodialysis therapy , 1 cases changed to intermittent peritoneal dialy-sis, after fistula healing, peritoneal dialysis were conti-nued.Conclusion Thoraco-abdominal fistula has the clinical features of intrathoracic negative pressure disappeared , with methylene blue test and radionuclide scan combined with pleural effusion ' s biochemical component analysis , the diagnosis of thoracic and abdominal fistula revealed high sensitivity , less adverse reac-tion.After occurred with thoraco-abdominal fistula , most patients changed to maintenance hemodialysis , peritoneal dialysis treatment is difficult to maintain .