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題名 | Video-assisted Thoracoscopic Surgery with Direct Suture and Pleurodesis for Diaphragmatic Defect in Patients on Continuous Ambulatory Peritoneal Dialysis--A Case Report=胸腔內視鏡輔助性直接縫合橫膈缺損及肋膜沾黏手術治療連續性腹膜透析病人併發大量水胸:一病例報告 |
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作者 | 謝志明; 張宏; 李世俊; Hsieh, Chih-ming; Chang, Hueng; Lee, Shih-chun; |
期刊 | 胸腔醫學 |
出版日期 | 20041200 |
卷期 | 19:6 2004.12[民93.12] |
頁次 | 頁503-508 |
分類號 | 416.22 |
語文 | eng |
關鍵詞 | 水胸; 連續性腹膜透析; 胸腔鏡手術; 橫膈缺損; 肋膜沾黏術; 直接修補; Hydrothorax; CAPD; VATS; Diaphragmatic defect; Pleurodesis; Direct suture; |
中文摘要 | 急性、大量且單側性水胸是連續性腹膜透析一個不常見但容易辨別的併發症。在經過近來發表的多項技術,包括只間斷連續性腹膜透析、經胸管的肋膜沾黏術或胸腔鏡肋膜沾黏術後,它的臨床病程及治療結果依然不清楚。在此我們介紹了一位與連續性腹膜透析相關的大量水胸且診斷為橫膈缺損的病例。我們成功地實施了胸腔鏡裂縫直接修補及肋膜沾黏手術。術中顯示缺損是由橫膈圓頂小泡泡破裂形成。術後,病人無水胸復發且可安全地進行連續性腹膜透析。我們強烈地建議對於連續性腹膜透析的病人,胸腔鏡橫膈缺損直接修補及肋膜沾黏手術為一較好的治療選擇方式。 |
英文摘要 | Acute, massive, unilateral hydrothorax is an uncommon but easily recognized complication of continuous ambulatory peritoneal dialysis (CAPD). Its clinical course and treatment outcome, with recently advocated variable techniques including interruption of CAPD alone, pleurodesis via chest drain, and video-assisted thoracoscopic surgery (VATS) with pleurodesis, remains unclear. We herein present a patient with CAPD-related massive hydrothorax who was diagnosed as having a diaphragmatic defect. VATS with direct suture of the flaw and pleurodesis were performed successfully. This revealed that the defect was attributable to the rupture of a small bleb in the diaphragmatic dome. After the operation, the patient had no recurrence of hydrothorax and underwent CAPD safely. We strongly suggest VATS with direct suture and pleurodesis, as the modality of choice, for diaphragmatic defects in patients on CAPD. |
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