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目的:阐明经剑突下穿刺猪尾导管心包引流并腔内化疗治疗恶性心包积液的有效性、安全性和实用性。方法:经剑突下心包穿刺置入猪尾导管于心包腔内间断引流。首次抽液量在500～600ml;24小时后抽液800～1000ml并腔内注射顺铂20mg;48小时抽完剩余积液再予以顺铂20mg腔内注射。引流间隙导管腔内灌注生理盐水,末端接一小三通并置于三不通状态。术后跟踪随访至患者死于原发病。结果:13例患者均为恶性心包积液。经治疗后心包积液消失8例;残余少量积液5例,但超声心动图随访发现积液无增多趋势。穿刺置管过程中无一例发生严重并发症。导管引流过程中,无一例出现导管滑脱、堵塞及心包腔内感染。随访发现无一例患者死于心包填塞。结论:经剑突下穿刺猪尾导管心包引流并腔内化疗治疗恶性心包积液可减轻恶性心包积液患者的痛苦,延长生命,是一有效、安全和实用的方法,值得临床推广使用。
Objective: To clarify the effectiveness, safety and practicability of pericardial drainage by percutaneous puncture of pigsty and intraperineal chemotherapy in the treatment of malignant pericardial effusion. Methods: The xiphoid pericardial puncture into the pigtail catheter intermittent drainage in the pericardial cavity. The first time the amount of pumping fluid in the 500 ~ 600ml; 24 hours after the pumping liquid 800 ~ 1000ml intracavity and cisplatin 20mg; 48 hours after pumping the remaining fluid and then cisplatin 20mg intracavity. Drainage catheter catheter perfusion of saline, the end of a small tee and placed in three unreasonable state. Postoperative follow-up to patients died of primary disease. Results: All 13 patients had malignant pericardial effusion. After treatment, pericardial effusion disappeared in 8 cases; residual small amount of effusion in 5 cases, but echocardiography follow-up found no increase in fluid accumulation trend. No serious complications occurred during puncture and catheterization. During catheter drainage, there was no catheter slippage, blockage and pericardial infection. Follow-up found no patient died of pericardial tamponade. CONCLUSIONS: Percutaneous drainage of pigtail catheters and intracavitary chemotherapeutic treatment of malignant pericardial effusion under the xiphoid puncture can reduce the pain and prolong the life of patients with malignant pericardial effusion, which is an effective, safe and practical method and is worthy of clinical application.