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目的比较经皮心包穿刺和剑下心包开窗治疗有症状心包积液的结果。方法回顾性分析10年间分别接受经皮心包穿刺和剑下心包开窗手术治疗的心包积液患者的结果。结果160例患者因症状性心包积液接受治疗,其中106例为剑下心包开窗,54例为经皮心包穿刺。经皮心包穿刺组并发症发生率为2%,与心包开窗组的5%相近(P=0.64)。心包开窗组中10例(11%)心包积液复发,6例(6%)出现心包缩窄;而经皮穿刺组有12例(25%)复发,10例(21%)发生缩窄(P=0.01)。单纯心包积液细胞学对恶性疾病的确诊率为19%,低于心包积液联合心包活检的确诊率(45%),有显著性差异(P=0.02)。结论经皮心包穿刺和心包开窗同样有效而安全。心包开窗治疗后的复发率和心包缩窄发生率较低,而且能够通过心包活检提高恶性疾病的确诊率。
Objective To compare the results of percutaneous pericardiocentesis and sphincter pericardial fenestration in the treatment of symptomatic pericardial effusion. Methods We retrospectively analyzed the results of pericardial effusion patients undergoing transperineal pericardiocentesis and perioperative fenestration in 10 years. Results 160 patients were treated with symptomatic pericardial effusion, of which 106 cases were sphincter pericardial fenestration and 54 cases were percutaneous pericardiocentesis. Percutaneous pericardial puncture group complication rate was 2%, and pericardial fenestration group 5% similar (P = 0.64). Pericardial effusion was recurred in 10 cases (11%) in the pericardial fenestration group and constriction of the pericardium in 6 cases (6%). In the percutaneous puncture group, 12 cases (25%) relapsed and 10 cases (21%) contracted (P = 0.01). Simple pericardial effusion cytology for the diagnosis of malignant disease was 19%, lower than the pericardial effusion combined with pericardial biopsy confirmed rate (45%), there was a significant difference (P = 0.02). Conclusions Percutaneous pericardiocentesis and pericardial fenestration are equally effective and safe. Pericardial fenestration after the recurrence rate and the incidence of constriction narrow, and can improve the diagnosis of malignant disease by pericardial biopsy.