胸腔置管引流联合电视胸腔镜胸膜剥脱术治疗结核性包裹性胸膜炎  

Thoracic catheter drainage combined with video-assisted thoracoscopic pleural dissection in the treatment of tuberculous encapsulated pleurisy

作　　者：任青青 汪娟 REN Qing-qing;WANG Juan(Department of Surgery,Ankang Central Hospital,Ankang,Shaanxi 725000,China)

机构地区：[1]安康市中心医院外科

出　　处：《中国临床研究》2019年第11期1511-1514,共4页Chinese Journal of Clinical Research

基　　金：陕西省科学技术研究发展计划项目(2017K15-02-792)~~

摘　　要：目的探讨胸腔置管引流联合电视胸腔镜胸膜剥脱术治疗结核性包裹性胸膜炎临床疗效及近中期预后效果。方法选取2011年1月至2015年7月120例结核性包裹性胸膜炎患者,按照治疗方式不同分为对照组60例与研究组60例。研究组采取胸腔置管引流+电视胸腔镜胸膜剥脱术,对照组采取常规开胸胸膜剥脱术。对比两组手术情况(手术用时、术中失血量、术后疼痛评分、术后带管时间、住院时间)、临床疗效、术前及术后6个月肺功能指标[最大自主通气量(MVV)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)]、并发症发生率和术后12、18个月疾病复发率。结果研究组手术用时、术中失血量、术后疼痛评分、术后带管时间短于对照组,差异有统计学意义(P<0.01);两组住院时间相比差异无统计学意义(P>0.05)。研究组总有效率(93.33%)高于对照组(78.33%),差异有统计学意义(P<0.05)。术后两组MVV、FVC、FEV1较术前增高,且研究组各指标高于对照组,差异有统计学意义(P<0.01)。研究组并发症发生率(6.67%)低于对照组(20.00%),差异有统计学意义(P<0.05)。研究组12、18个月疾病复发率(1.67%、5.00%)低于对照组(5.00%、10.00%),但差异无统计学意义(P>0.05)。结论采用胸腔置管引流联合电视胸腔镜胸膜剥脱术治疗结核性包裹性胸膜炎效果显著,可减少手术创伤,改善患者肺功能,提高治疗效果,且术后并发症较少,利于降低疾病复发率,可改善近中期预后效果。Objective To investigate the clinical efficacy and short-term and medium-term prognosis of tuberculous encapsulated pleurisy treated by thoracic catheter drainage combined with video-assisted thoracoscopic pleural dissection.Methods A total of 120 patients with tuberculous encapsulated pleurisy treated from January 2011 to July 2015 were selected and were divided into control group and study group according to different treatment methods(n=60,each).The thoracic catheter drainage and video-assisted thoracoscopic pleural exfoliation was performed in study group,while conventional open pleural exfoliation was conducted in control group.The operation time,intraoperative blood loss,post-operative pain score,postoperative intubation time,hospitalization time,clinical efficacy,pulmonary function indexes [maximum autonomous ventilation(MVV),forced vital capacity(FVC),forced expiratory volume in the first second(FEV1)],complications and recurrence rate during postoperative 12 and 18 months were compared between two groups.Results The operation time,intraoperative blood loss,post-operative pain score and postoperative intubation time in study group were significantly shorter than those in control group(P<0.01),and the total effective rate was higher than that in control group(93.33% vs 78.33%,P<0.05).There was no significant difference in hospitalization time between two groups(P>0.05).MVV,FVC and FEV1 were statistically higher than those before operation in two groups and were higher in study group than those in control group(P<0.01).The incidence of complications in study group was significantly lower than that in control group(6.67% vs 20.00%,P<0.05).The recurrence rate at 12 and 18 months in study group(1.67%, 5.00%) was lower than in control group(5.00%,10.00%), but the difference was not statistically significant(P>0.05).Conclusions Thoracic catheter drainage combined with video-assisted thoracoscopic pleural dissection is effective in the treatment of tuberculous encapsulated pleurisy.It can reduce surgical trauma,i

关 键 词：结核性包裹性胸膜炎 胸腔置管引流 电视胸腔镜胸膜剥脱术 肺功能 预后 

分 类 号：R655.2[医药卫生—外科学] R521.7[医药卫生—临床医学]