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腹膜透析患者腹腔和胸腔缺陷的诊断方法

Author
Madhukar Misra, MD, FRCP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
毛志国, 副主任医师，副教授

引言

透析液在腹腔内会增加腹内压，并可能导致透析液从腹壁和胸壁的获得性或先天性缺陷处渗漏。这可能表现为胸腔积液、疝或生殖器/腹壁水肿。 (参见“腹膜透析管的非感染性并发症”和“持续腹膜透析的非感染性并发症”和“持续性腹膜透析中的腹壁疝”)

先前就已有各种诊断方法用于帮助诊断这些缺陷。在20世纪70年代，常使用X线平片、导管对比造影显像和腹膜造影术。然而，由于这些方法稍微不够准确并具有误导性[1]，已被放射学方法所替代。这些较新的方法包括使用造影剂/染剂的同位素扫描(腹膜闪烁成像)、计算机断层成像(computed tomography, CT)扫描[CT腹膜造影术(CT peritoneography, CTP)]和磁共振成像(magnetic resonance imaging, MRI)[磁共振腹膜造影术(MR peritoneography, MRP)]。

这篇专题将讨论用于检测腹膜透析(peritoneal dialysis, PD)患者的腹壁和胸壁缺陷的诊断方法。对PD患者的一般问题的综述，包括提示疝、腹膜漏和/或胸膜漏的临床表现，参见其他专题。 (参见“腹膜透析管的非感染性并发症”)

腹膜闪烁成像

腹膜闪烁成像是诊断腹腔漏的一种安全、准确且快速的方法[2-5]。含有3-5毫居里锝-99m的0.5-2L的透析溶液被注入腹腔，然后采用多个投射位(前位，侧位，后位和斜位)以帮助将腹壁漏与其后的腹膜液区分开[6]。

尽管使用了大剂量的同位素，但其并不会被腹膜吸收，且几乎所有的同位素物质在成像检查后都会被排出体外，因此辐射的净剂量仅为滴注入腹膜腔的总剂量的一小部分[7]。

        

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Literature review current through: 2017-06 . | This topic last updated: 2015-12-07.
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