红斑狼疮胸膜炎继发纤维胸、严重受限肺及其胸膜切除术的成功治疗

摘要

胸膜疾病是系统性红斑狼疮(SLE)常见的肺部表现，通常对皮质类固醇和其他免疫抑制剂有反应。在本报告中，一种新的方法，胸膜去皮术，被用于一个重症SLE继发的药物难治性慢性胸膜炎患者。一个26岁的女性已知SLE发展进行性呼吸困难和胸膜炎胸痛几个月。她红斑狼疮的其他全身表现用环磷酰胺和强的松控制住了。计算机断层扫描显示持续的，小的，位于右侧胸腔积液;胸膜增厚;右肺中下叶不张。肺功能检查显示有严重的限制性缺陷尽管进行了最大限度的药物治疗，患者仍因严重的呼吸困难而致残，因此，考虑进行手术。右胸廓切开术发现右肺被致密的脏胸膜包裹。 Decortication was performed. On pathology, pleuritis with vascular pleural adhesions was found. No lupus pneumonitis was noted. Postoperatively, a significant clinical improvement in dyspnea was evident within several weeks. On a 6 min walk test, the patient achieved 384 m with a Borg dyspnea scale rating of 2 compared with 220 m and a Borg dyspnea scale rating of 4 preoperatively. Her forced vital capacity improved from 24% predicted to 47% predicted, and her total lung capacity improved from 35% predicted to 54% predicted. Medical therapy of systemic lupus erythematosus has been proven to be effective in controlling pleuritis in most cases. However, in the event of refractory pleuritis or pleural thickening, decortication may be a viable alternative.

加拿大呼吸杂志

红斑狼疮胸膜炎继发纤维胸、严重受限肺及其胸膜切除术的成功治疗

摘要

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