- 期刊
利用鎝-99m-sulfur colloid評估接受腹膜透析病人之急性胸膜腔積水
Hydrothorax in Patients Receiving Continuous Ambulatory Peritoneal Dialysis Demonstrated by 99mtc-Sulfur Colloida
摘要
前言：急性胸膜腔積水(hydrothorax)對連續可活動性腹膜透析病人是一種不常見的併發症。本文利用核醫之腹胸膜閃爍造影術，成功診斷出7例因透析造成腹胸膜交通(peritoneopleural communication,PPC)引起之胸膜腔積水病例。方法：本回顧性研究收集從1994年11月至1999年7月止，在林口及基隆長庚紀念醫院共有7位腎病末期病人在接受腹膜透析期間疑似透析造成腹胸膜交通而引起胸膜腔積水。腹胸膜閃爍造影術是利用6mCi(222MBq)鎝-99m-sulfur colloid經由腹膜透析管(Tenckhoff catheter)注入腹腔内，注射後5分鐘、15分鐘、30分鐘、45分鐘、1小時及2小時在病人胸部及上腹部進行前位造影。結果：7位病人當中，有1位在放射性示踪劑注入腹腔後5分鐘即可見到胸腔有同位素的聚集，4位在30分鐘、1位在45分鐘、另1位在50分鐘後可見到胸腔有同位素的聚集。6位可見到右側之腹胸膜交通，另1位則為左側。所有急性胸膜腔積水病患在暫時停止腹膜透析或改成血液透析之後，胸腔積水情況皆消失不見。結論：核醫腹胸膜閃爍造影術能夠迅速、簡單、正確，又不具侵襲性地協助臨床醫師成功地診斷出PPC，尤其對腎病末期合併糖尿病或其他可能導致慢性胸膜腔積水的病症時，是一項値得鼓勵的檢查方法。
並列摘要
Background: Acute hydrothorax is an uncommon but well-known complication of continuous ambulatory peritoneal dialysis(CAPD).In this study,99mTc-sulfur colloid(SC)peritoneopleural scintigraphy was successfully used to identify7 uremic patients who had peritoneopleural communication(PPC)induced hydrothorax while receiving CAPD. Methods: From Nov.1994 to Aug.1999,7 end-stage renal disease(ESRD)patients developing acute hydrothorax while receiving CAPD were enrolled in this retrospective study.6mCi(222MBq)of 99mTc-SC was administrated intraperitoneal(i.p.)through the Tenckhoff catheter. Anterior abdominal and chest planar images were performed at5min,15min,30min,45min,1hr,1.5hrs,and 2hrs after i.p. injection. Results: One from these 7 cases was proved to be a victim of PPC at 5min after i.p.injection,4 at 30min,1 at 45min,and 1 at 50min were proved to have PPC after injection, respectively. The PPC was located on the right side in6 patients and on the left side in only one patient. Hydrothorax resolved in all patients following temporarily discontinuing CAPD or switching to hemodialysis. Conclusions: Our study showed that this scintigraphy can easily demonstrate PPC within only 1hr after i.p. injection. We thus suggest that peritoneopleural scintigraphy is a simple, non-invasive and safe modality for demonstrating trans-diaphragmatic fluid leakage in peritoneal dialysis patients, especially for those with DM or other possible chronic pleural effusion.
延伸閱讀
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