Multiple Diaphragmatic Defects Complicated with Acute Hydrothorax in a Peritoneal Dialysis Patient-A Case Report

腹膜透析患者併發橫膈缺損及急性水胸－病例報告

陳煥威(Huan-Wei Chen) ； 林楷煌(Kai-Huang Lin) ； 劉小華(Hsiao-Hua Liu) ； 陳皇吉(Huang-Chi Chen)

《胸腔醫學》 30卷5期 (2015/10) Pp. 314-320

摘要

腹膜透析是末期腎病的患者，在接受腎臟替代療法中的一種選擇，目前來說確實愈來愈被廣為使用。在所有與腹膜透析相關的併發症中，水胸這個併發症的發生比例相對較低，而且這個疾病也有其特殊的表現。我們所提的這個病例報告是一位51歲因為末期腎病而接受腹膜透析的女性患者，她就醫主要的問題是一個禮拜的乾咳以及愈來愈厲害的呼吸喘促。胸部X光顯示有大量的右側肋膜積液，而且肋膜積液的分析顯示出有高的葡萄糖含量。我們安排腹部的鎝-99m閃爍攝影檢查，發現在右邊肺野的放射線活性增高，顯然有胸腔腹腔交通的問題存在。影像輔助的胸腔內視鏡檢查發現有多處橫膈缺損，因此接著做內視鏡橫膈修補。之後，這個患者將她的腎臟替代療法改為血液透析，也不再有水胸的這個問題復發。針對這樣一個腹膜透析相關的水胸，生化和影像方面的檢查都有助於診斷的確立。而且影像輔助的胸腔內視鏡檢查合併內視鏡修補，理應是一個適當的治療選項。

關鍵字

水胸 ； 胸腔腹腔交通 ； 腹膜透析

並列摘要

Peritoneal dialysis, a renal replacement therapy, is being increasingly used for patients with end-stage renal disease. Of all the complications related to peritoneal dialysis, hydrothorax is rather less common. Hydrothorax related to peritoneal dialysis has its unique presentation. We report a 51-year-old woman who received peritoneal dialysis for her endstage renal disease and presented to our hospital with non-productive cough and progressive deteriorated shortness of breath for 1 week. The chest X-ray showed a massive amount of right-side pleural effusion, and the pleural fluid analysis revealed it was transudative with a high glucose content. We arranged peritoneal scintigraphy with a technetium-99m Phytate shunt scan and the result showed increased activity in the right lung field, suggestive of the existence of pleuro-peritoneal communication. Video-assisted thoracoscopy was arranged, and showed multiple diaphragmatic defects. Surgical diaphragmatic repair was then performed with endoscopic suture. Thereafter, the patient changed her renal replacement therapy to hemodialysis. No recurrent hydrothorax was found in the subsequent followup course. For the diagnosis of hydrothorax related to peritoneal dialysis, biochemistry and imaging studies are indicated, and video-assisted thoracoscopy with endoscopic suture would be a reasonable treatment choice.

並列關鍵字

hydrothorax ； pleuro-peritoneal communication ； peritoneal dialysis