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Vol. 13. Issue 1.
Pages 71-81 (January - February 2007)
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Vol. 13. Issue 1.
Pages 71-81 (January - February 2007)
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Derivação pericardioperitoneal no tratamento de derrames pericárdicos em doentes neoplásicos
Pericardioperitoneal shunt in the treatment of pericardial effusions in neoplasic patients
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Nuno Cortesão1,
, Ana Figueiredo2, Fernando Barata3, António Correia de Matos4, Carlos Janelas4
1 Interno Complementar de Pneumologia
2 Assistente de Pneumologia
3 Assistente Graduado de Pneumologia – Serviço de Pneumologia do Centro Hospitalar de Coimbra. Director: Dr. Jorge Pires
4 Chefe de Serviço – Sector de Cirurgia Torácica do Centro Hospitalar de Coimbra. Director: Dr. Carlos Janelas
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Resumo

Os derrames pericárdicos que surgem num contexto neoplásico são frequentes e apresentam dificuldades de diagnóstico e tratamento. Apesar de surgirem em doentes com neoplasia, 50% destes derrames têm uma etiologia benigna; surgem por mecanismos paralelos, indirectamente relacionados com o tumor. Os restantes (derrames pericárdicos neoplásicos – DPN) resultam do atingimento tumoral das estruturas peri ou epicárdicas e assumem, por si só, um pior prognóstico. As opções de tratamento disponíveis são várias, mas a ausência de normas orientadoras da sua aplicação tornam difícil avaliar perfis de rentabilidade, eficácia e segurança. A derivação pericardioperitoneal (DPP) é um método cirúrgico de drenagem da cavidade pericárdica que se tem demonstrado muito útil em DPN. No CHC, esta técnica é efectuada com o auxílio de toracoscopia videoassistida (VATS). Nos últimos 8 anos, foram submetidos a esta modalidade terapêutica 18 doentes com DPN. A técnica demonstrou ser segura, eficaz e com baixa morbilidade/mortalidade.

Palavras-chave:
Derrame pericárdico
Neoplasia
Derivação pericardioperitoneal
Drenagem pericárdica
Abstract

Neoplasia-related pericardial effusions are a frequent finding and pose diagnostic and therapeutic challenges. Although they appear in the context of an underlying neoplastic disease, 50% of these effusions have a benign etiology; they are indirectly caused by the tumor. The remaining cases (neoplastic pericardial effusions – NPE) derive from extension of tumoral disease to the epi and/or pericardium and have, therefore, a worst prognosis. Despite several treatment options, the lack of apropriate guidelines difficults the evaluation of their efficacy and safety. Pericardioperitoneal shunt (PPS) is a surgical pericardial drainage method, which has demonstrated its usefulness in the management of NPE. At the CHC, this procedure is performed under videoassisted toracoscopic guidance (VATS). During the last 8 years, 18 patients have been submitted to this therapeutic option, which proved to be safe, efficacious and with low morbimortality rates.

Key-words:
Pericardial effusion
Neoplasia
Pericardioperitoneal shunt
Pericardial drainage
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Copyright © 2007. Sociedade Portuguesa de Pneumologia
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