结核性胸膜炎继发包裹性脓胸手术时机探讨  

Study on the Proper Operation Time of Patients with Encapsulated Empyema Secondary to Tuberculous Pleurisy

作　　者：王冲 杨磊[1] 闫东杰[1] 刘树库[1] Wang Chong, Yang Lei, Yan Dongjie, Liu Shuku(Minimally Invasive Treatment Center, Beijing Chest Hospital, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京胸科医院微创诊疗中心,101149

出　　处：《结核病与胸部肿瘤》2018年第3期193-196,共4页Tuberculosis and Thoracic Tumor

摘　　要：目的回顾性分析结核性胸膜炎继发包裹性脓胸行手术治疗的病例特点，以病程长短为基本标准，探讨其手术干预时机。方法1995年12月至2017年5月行胸膜剥脱术治疗235例结核性胸膜炎继发包裹性脓胸患者，男189例，女46例；中位年龄40岁（9～75岁）。右侧疾病126例，左侧109例，中位脓胸范围5．4个肋间（4～10个肋间）。将患者按病程长短分为3组：A组113例，512个月；B组53例，12～24个月；C组69例，〉24个月。使用倾向得分匹配法平衡各组间基线资料差异。比较3组手术时长、手术出血、围手术期并发症、住院天数等指标。结果A组B组、B组c组分别进行两两倾向得分匹配。匹配后，A组B组各45例，B组C组各29例。B组手术时长、出血量、输血量显著高于A、C组。B组带管时间、住院时间显著长于A组，但与C组差异无统计学意义（P〉0．05）。3组间在术后并发症方面差异无统计学意义（P〉0．05）.结论内科治疗无效的包裹性脓胸，早期（发病1年以内）或等待纤维板成熟（病程超过2年）行手术干预是可行的治疗方案，尽量避免在高危期（发病1～2年）行手术治疗。Objective To discuss the proper operation time of patients with encapsulated empyema secondary to tuberculous pleurisy by review the clinical characteristics and duration of these patients. Methods From December 1995 to May 2017, 235 patients with encapsulated empyema and pleural decortication were operated. The course of disease and preoperational data were collected.Patients were divided into three groups according to the duration of disease （ group A with 113 cases, 〈12 months ; group B with 53 cases, 12 -24 months ; group C with 69 cases, 〉 24 months）. Propensity score matching （ PSM ） was used to decrease the baseline difference among three groups.Preoperational features, such as operation time, bleeding, complications were compared between groups. Results PSM were conducted between group A and group B （ 45 paired patients ）, group B and group C （ 29 paired patients ）, respectively. The length of operation, amount of bleeding and blood transfusion in group B were significantly higher than those in group A and group C. The days with tube and hospitalization in group B were significantly longer than group A, but they were insignificantly different compared with group C （P 〉0.05）. Postoperative complications were similar between the three groups（P 〉 0.05）. Conclusion Encapsulated empyema in early stage （within 1 year of onset ） or after the maturation of the fibrous plate （ over 2 years ） is less difficult for surgical intervention, and try to avoid surgical treatment at high risk（1 to 2 years）.

关 键 词：包裹性脓胸 手术时机 胸膜剥脱术 

分 类 号：R521.7[医药卫生—内科学]