Derivação pericardioperitoneal no tratamento de derrames pericárdicos em doentes neoplásicos

Pericardioperitoneal shunt in the treatment of pericardial effusions in neoplasic patients

 

Nuno Cortesão¹

Ana Figueiredo²

Fernando Barata³

António Correia de Matos⁴

Carlos Janelas⁴

 

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 use-fulness 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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Full text only available in PDF format.

 

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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.

 

Centro Hospitalar de Coimbra (CHC)

Quinta dos Vales S. Martinho do Bispo 3041-801 Coimbra

 

Recebido para publicação/received for publication: 05.09.22

Aceite para publicação/accepted for publication: 06.10.20