内科胸腔镜介入治疗肺大疱并难治性自发性气胸  

Evaluation of medical thoracoscopy for the pulmonary bullae with refractory spontaneous pneumothorax

作　　者：刘庆华[1] 许小婷 姚周虹[1] 王成 赵娜 万云焱[1] 曾奕明[4] 林殿杰[1] Liu Qinghua;Xu Xiaoting;Yao Zhouhong;Wang Cheng;Zhao Na;Wan Yunyan;Zeng Yiming;Lin Dianjie.(Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250014, China)

机构地区：[1]山东大学附属省立医院呼吸科,济南250014 [2]泉州市第一医院呼吸科,362000 [3]山东中医药大学第二临床医学院呼吸科,济南250001 [4]福建医科大学附属第二医院呼吸科,泉州362000

出　　处：《国际呼吸杂志》2018年第10期741-745,共5页International Journal of Respiration

基　　金：2015年山东省科技发展重点研发计划项目（2015GSF118184）

摘　　要：目的 探讨内科胸腔镜下介入治疗肺大疱并难治性自发性气胸 （SP）的疗效和安全性。方法 收集近5年我院肺大疱并难治性SP经内科胸腔镜下介入治疗病例,包括内科胸腔镜下滑石粉喷洒、氩气刀 （APC）处理肺大疱、自体血和红霉素胸腔注入等多种方法联合治疗,评价其临床疗效和安全性。术后≥12个月无同侧SP复发定义为治愈;≥6个月为治疗进步;〈6个月为治疗失败。结果 共计23例自发性气胸患者进行了内科胸腔镜检查,其中符合本研究入组条件患者8例,共计10例次内科胸腔镜下治疗,随访至少1.5年。应用滑石粉喷洒或联合 APC患者术后拔管时间5-13d不等,应用APC无论是否联合自体血和红霉素胸腔注入,如未应用滑石粉喷洒,术后拔管时间均在2周以上,最长达50d。治愈率90%,治疗进步10%,失败率0%。2例分别于术后7个月和3年同侧SP复发。无严重并发症。结论 肺大疱并难治性SP内科胸腔镜下介入治疗是供考虑的安全有效措施之一,滑石粉胸膜闭锁疗效较好;内科胸腔镜下APC介入治疗相对安全,但单一措施价值有限,部分患者仍持续漏气,术后建议联合自体血或红霉素胸腔注入提高治疗成功率。objective To investigate the efficacy and safety of pulmonary bullae with refractory spontaneous pneumothorax （SP） treated with medical thoraeoseopy. Methods Patient with pulmonary bullae and refractory SP treated by pouring tale, autologous blood and/or erythromycin into pleural cavity under medical thoracoseopy in our hospital within recent 5 years were collected. The efficacy and complications of these interventional methods were evaluated. Criterion for therapeutic effect ： no ipsilateral SP recurrence within 12 months after thoracoscopy was considered as cure; No ipsilateral SP recurrence within 6 months was considered as improved; While ipsilateral SP recurrence within 6 months was considered as failure. Results Total 23 patients with pneumothorax were given medical thoracoscopy examination. Eight eligible cases with 10 medical thoracoscopy procedures were followed up more than 1.5 years. Removal time of chest drainage tube in patients with application of talc powder spraying with or without APC under medical thoraeoscopy were 5-13 days after thoracoscopy. However, removal time with application APC without talc powder would be more than 14 days even up to 50 days no matter together with or without pouring autologous blood and erythromyein into pleural cavity. The cure rate was 90 %, improved rate was 10%, and none failed. Ipsilateral SP recurrence occurred 7 months and 3 years later in 2cases respectively. No serious complications developed. Conclusions Medical thoracoscopy for pulmonary bullae with refractory SP is an alternative effective and safe approach which deserves further investigation. Talc power spray under medical thoracoseopy is rather effective;APC is another safety method but with limited value;Autologous blood or erythromycin is recommended to inject into pleural cavity after APC utilization.

关 键 词：内科胸腔镜 自发性气胸 肺大疱 滑石粉 自体血 红霉素 

分 类 号：R563[医药卫生—呼吸系统]