超声定位内科胸腔镜治疗急性脓胸的研究  

Ultrasonographic study for the treatment of thoracic empyema by medical thoracoscopy

作　　者：周朕[1] 杜黎明[1] 谢德荣[1] 胡学宁[2] 

机构地区：[1]湖北省黄石市中心医院,湖北黄石435000 [2]武汉大学附属中南医院,湖北武汉430071

出　　处：《中国内镜杂志》2010年第10期1082-1085,共4页China Journal of Endoscopy

基　　金：湖北省黄石市市级科技攻关项目(200901)

摘　　要：目的探讨复杂性类肺炎性胸腔积液和急性脓胸的最适治疗途径。方法 31例临床诊断为复杂性类肺炎性胸腔积液或急性脓胸的患者,随机分入胸腔闭式引流结合胸腔内注射链激酶组(CT-SKs,n=15)和可视化内科胸腔镜治疗组(VMTs,n=16)。比较各自疗效,胸腔闭式引流天数、住院天数、住院费用以及1次治疗成功率等。结果和CT-SKs相比,VMTs初次治疗成功率显著增高(94%vs47%),P<0.05;带管引流时间缩短(6.40±0.42)vs(7.93±0.27)d,P<0.05);缩短住院时间([15.13±0.29)vs(18.13±0.39)]d,P<0.05;降低住院费用([11302.13±291.29)vs(16034.67±345.64)]元,P<0.05。CT-SKs治疗失败的病例可以及时使用内科胸腔镜继续治疗。结论在诊治复杂性类肺炎性胸腔积液和急性脓胸时,与常规胸腔引流法相比,可视化内科胸腔镜治疗效果更好,值得临床推广。【Objective】To determine the optimal treatment of complicated parapneumonic effusions and acute empyema.【Methods】Twenty one patients with confirmed parapneumonic effusions and acute thoracic empyema were randomized to receive either chest tube pleural drainage plus streptokinase （CT-SKs, n =15） or visualing medical thoracoscopy （VMTs, n=16）. Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was performed. 【Results】When compared with the CT-SK group, the VMT group had a significantly higher primary treatment success [15/16, 94% vs 7/15. 47%; P 0.05], lower chest tube duration [（6.40±0.42） vs （7.93±0.27） days; P 0.05], lower number of total hospital days [（15.13±0.29） vs （18.13±0.39） days; P 0.05], and lower hospital costs [$（11, 302.13±291.29） vs $（16, 034.67 ±345.64）, P 0.05] also favored the VMTs group. All the CT-SKs treatment failures could be salvaged with VMTs. 【Conclusions】In patients with complicated parapneumonic effusions and thoracic empyema, a primary treatment strategy of VMTs is associated with a higher efficacy than a treatment strategy that utilizes catheter-directed fibrinolytic therapy. It needs to be further practised and studied.

关 键 词：内科胸腔镜 复杂性类肺炎性胸腔积液 急性脓胸 

分 类 号：R561[医药卫生—呼吸系统]