5. Хирургические операции

1. Перикардиоцентез должен быть первичной процедурой при больших количествах перикардиального выпота. При рецидивах следует рассмотреть вопрос об использовании склерозирующих агентов, инстиллируемых в перикард для предотвращения реаккумуляции жидкости (доксициклин, блеомицин, тиотепа).^50,51

2. Субксифоидальное перикардиальное окно используется для дренирования перикардиального пространства, получения небольшого образца для биопсии и облитерации перикардиального пространства путем слипания. Несмотря на низкую частоту рецидивов, эту процедуру лучше резервировать для пациентов с терминальной стадией онкологической патологии.

3. Перикардэктомии через левый антелатеральный торакотомный доступ, или срединную стернотомию, очень эффективны в профилактике рецидивов выпота. Лучшим доступом при констриктивных перикардитах является срединная стернотомия в сочетании с готовым АИКом. Перикард удаляют между ножками диафрагмальных нервов или сбоку, или в той мерее насколько позволяет доступ. Для предотвращения отека легких, который встречается, когда правый желудочек освобождается, а левый остается констриктированным, декортикацию левого желудочка следует выполнять в первую очередь.

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