内科胸腔镜治疗复杂性肺炎旁胸腔积液的研究  

Complicated parapneumonic effusions treated by medical thoracoscopy

作　　者：杜黎明[1] 周朕[1] 王曾[1] 谢德荣[1] 

机构地区：[1]湖北省黄石市中心医院,湖北黄石435000

出　　处：《山东大学学报（医学版）》2010年第9期82-84,88,共4页Journal of Shandong University:Health Sciences

基　　金：湖北省黄石市市级科技攻关项目(200901)

摘　　要：目的讨论复杂性肺炎旁胸腔积液(complicated parapneumonic effusions,CPE)的最佳治疗方法。方法 21例临床诊断为CPE的患者随机分为胸腔闭式引流结合胸腔内注射链激酶组(CT-SKs,n=10)和内科胸腔镜治疗组(MTs,n=11)。比较2组疗效、住院天数、胸腔引流天数、住院费用以及一次治疗成功率等。结果与CT-SKs相比,MTs初次治疗成功率显著增高[10/11(91%)vs4/10(40%),P<0.05],带管引流时间缩短[(5.8±1.1)dvs(9.8±1.3)d,P<0.05),住院时间缩短[(8.7±0.9)dvs(12.8±1.1)d,P<0.05),住院费用降低[(11045±3411)元vs(18475±5164)元,P<0.05]。所有CT-SKs治疗失败的病例可以使用内科胸腔镜继续治疗而不需要外科手术治疗。结论与常规胸腔引流法相比,内科胸腔镜治疗CPE能缩短住院时间、节省住院费用、获得更好的疗效,值得进一步临床实践推广。Objective To determine the optimal treatment of complicated parapneumonic effusions.Methods Twenty-one patients with confirmed parapneumonic effusions were randomly divided to receive either chest tube pleural drainage plus streptokinase （CT-SKs,n=10） or medical thoracoscopy （MTs,n=11） .Outcome analysis with respect to treatment efficacy,hospital duration,chest tube duration,hospital costs,and need for subsequent procedures was performed.Results Compared with the CT-SK group,the MT group had a significantly higher primary treatment success [10/11, 91% vs 4/9,40% ; P0.05 Fisher＇s Exact Test],lower chest tube duration （5.8±1.1 vs 9.8±1.3 days; P0.03） ,shorter total hospital days （8.7±0.9 vs 12.8±1.1 days; P0.05） ,and less hospital costs （11 045±3 411 vs 18 475±5 164,P0.05） also favored the MTs group.Of note,all the CT-SKs treatment failures could be salvaged with MTs,and none required thoracotomy.Conclusion In patients with complicated parapneumonic effusions and thoracic empyema,a primary treatment strategy of MTs is associated with a higher efficacy,shorter hospital duration,and less cost than a treatment strategy that utilizes catheter-directed fibrinolytic therapy.

关 键 词：肺炎 胸腔积液 胸腔镜 治疗结果 

分 类 号：R563.1[医药卫生—呼吸系统]