流程优化方法完全胸腔镜下慢性结核性脓胸手术76例诊治分析  

Analysis of diagnosis and treatment of 76 cases of chronic tuberculous empyema treated by complete thoracoscopy with process optimization method

作　　者：张瑛 劳海军 林兵 刘俊婷 孙冬梅 Zhang Ying;Lao Haijun;Lin Bing;Liu Junting;Sun Dongmei(Department of Thoracic Surgery,the Fourth Hospital in Chaoyang City,Liaoning Province,Chaoyang 122000,China)

机构地区：[1]辽宁省朝阳市第四医院胸外科,朝阳122000

出　　处：《结核与肺部疾病杂志》2023年第4期308-312,共5页Journal of Tuberculosis and Lung Disease

摘　　要：目的:探讨流程优化方法完全电视胸腔镜下治疗慢性结核性脓胸的可行性。方法:回顾性分析2015年4月至2019年2月在辽宁省朝阳市第四医院接受流程优化方法完全胸腔镜手术治疗的76例慢性结核性脓胸患者临床资料。流程优化手术方法主要包括改变胸腔镜手术切口设计顺序、改进胸腔镜操作空间建立技术、统一纤维板剥脱顺序流程、独特的胸腔引流管放置方法等。以患者术后完成9~18个月的规范化抗结核药物治疗时间为节点,评定患者的治疗效果。结果:76例患者均顺利完成电视胸腔镜手术,共实施77例次手术,其中1例双侧慢性结核性脓胸患者进行了分期手术,无中转开胸。手术持续时间为60~260 min,中位数(四分位数)为120(90,160)min;术中出血量为150~2000 ml,中位数(四分位数)为700(540,800)ml;引流管留置时间为4~22 d,中位数(四分位数)为7(6,11)d;术后住院时间为6~26 d,中位数(四分位数)为8(7,13)d。术后并发症发生率为19.5%(15/77),包括切口延期愈合6例,肺持续漏气8例,乳糜胸1例。术后随访9~55个月,中位数(四分位数)为26(20,37)个月;无复发患者,无二次手术患者。患者的远期疗效显示,88.2%(67/76)达到Ⅰ级,9.2%(7/76)达到Ⅱ级,2.6%(2/76)达到Ⅲ级。结论:采用流程优化方法完全电视胸腔镜手术治疗慢性结核性脓胸,远期疗效良好,对于存在手术适应证的患者可以考虑采用此种术式。Objective:To explore the feasibility of the process optimization method in the treatment of chronic tuberculous empyema under complete thoracoscopy.Methods:The data of 76 patients with chronic tuberculous empyema who underwent complete thoracoscopic surgery with procedure optimization method in the Fourth Hospital in Chaoyang City from April 2015 to February 2019 were retrospectively analyzed.The process optimization methods mainly include changing the incision design sequence of thoracoscopic surgery,improving the technology of thoracoscopic operation space establishment,unifying the sequence of fiberboard stripping,and unique thoracic drainage tube placement.The evaluation time of long-term efficacy was based on the time of 9-12 months of standardized anti-tuberculosis drug treatment after surgery.Results:Video-assisted thoracoscopic surgery was successfully completed in all 76 patients,and a total of 77 surgeries were performed,among which 1 patient with bilateral chronic tuberculous empyema underwent staging surgery without conversion to thoracotomy.The operation lasted 60 to 260 minutes,with the median of 120(90,160)minutes,and the intraoperative bleeding was 150 to 2000 ml,with the median of 700(540,800)ml.Drainage tube indwelling time was 4-22 days(median,7(6,11)days).Postoperative hospitalization lasted 6 to 26 days(median,8(7,13)days).The incidence of postoperative complications was 19.5%(15/77),including delayed incision healing in 6 cases,persistent lung leakage in 8 cases and chylothorax in 1 case.Postoperative follow-up was 9 to 55 months(median,26(20,37)months),no cases recurrence or underwent second operation.The long-term outcome was evaluated:88.2%(67/76)achieved gradeⅠ,9.2%(7/76)achieved grade Ⅱ,and 2.6%(2/76)achieved grade Ⅲ.Conclusion:The long-term effect of complete video-assisted thoracoscopic surgery used to treat chronic tuberculous empyema by process optimization method is good.For patients with surgical indications,it is worth promoting.

关 键 词：胸外科手术 电视辅助 脓胸 结核性 外科手术 微创性 治疗结果 

分 类 号：R61[医药卫生—外科学] R52[医药卫生—临床医学]