尿激酶冲洗胸腔治疗自发性食管破裂的临床疗效及安全性  

Clinical efficacy and safety of intrapleural urokinase irrigation in the treatment of spontaneous esophageal rupture

作　　者：张伟清[1] 黄金龙[1] 林栋梁[1] 许振东[1] ZHANG Weiqing;HUANG Jinlong;LIN Dongliang;XU Zhendong(Department of Thoracic Surgery,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian,362000,China)

机构地区：[1]福建医科大学附属泉州第一医院胸外科,福建泉州362000

出　　处：《当代医学》2024年第6期143-146,共4页Contemporary Medicine

摘　　要：目的探讨尿激酶冲洗胸腔治疗自发性食管破裂的临床疗效及安全性。方法回顾性分析2008年1月至2021年12月福建医科大学附属泉州第一医院收治的56例自发性食管破裂患者的临床资料,根据术后胸腔冲洗方式分为研究组(n=26)与对照组(n=30)。两组均接受Ⅰ期破裂修补术,研究组术后常规行尿激酶冲洗胸腔,对照组术后行单纯0.9%氯化钠溶液冲洗或不冲洗。比较两组术后包裹性积液发生率、再次胸腔引流率、胸管拔除时间、抗生素使用时间、住院时间、恢复经口进食时间,并采用单因素及二分类Logistic回归分析术后发生包裹性积液的影响因素。结果56例患者中,开胸修补35例,经腔镜修补21例,无死亡病例。研究组术后均未发生胸腔出血、过敏反应、发热等不良反应。研究组术后包裹性积液发生率、再次胸腔引流率均低于对照组,胸管拔除时间、住院时间、恢复经口进食时间均短于对照组,差异有统计学意义(P<0.05);两组抗菌素使用时间比较差异无统计学意义。56例患者中,术后发生包裹性积液29例,未发生包裹性积液27例。发生包裹性积液患者发病至手术时间>12h、食管破口长度≤4cm及未使用尿激酶冲洗比例高于未发生包裹性积液患者,差异有统计学意义(P<0.05),二者性别、年龄、破口位置、破口方向、手术方式比较差异无统计学意义。二分类Logistic回归分析结果显示,未使用尿激酶冲洗、发病至手术时间>12h是术后发生包裹性积液的独立影响因素(P<0.05)。结论采用尿激酶冲洗胸腔有利于降低自发性食管破裂修补术后包裹性积液发生率,促进患者快速康复,是一种安全有效的治疗方法,值得临床推广应用。Objective To explore the clinical efficacy and safety of intrapleural urokinase irrigation in the treatment of spontaneous esophageal rupture.Methods The clinical data of 56 patients with spontaneous esophageal rupture who were admitted to the Quanzhou First Hospital affiliated to Fujian Medical University from January 2008 to December 2021 were retrospectively analyzed,they were divided into the study group(n=26)and the control group(n=30)according to postoperative thoracic irrigation methods.Both groups received surgical stageⅠrupture repair,the study group received intrapleural urokinase irrigation,while the control group received 0.9%sodium chloride solution irrigation or no irrigation.The incidence of postoperative encapsulated effusion,the rate of postoperative thoracic drainage,the time of chest tube removal,the time of antibiotic use,the time of hospitalization,and the time of recovery of oral feeding were compared between the two groups,univariate and binary Logistic regression analysis was used to analyze the influencing factors of postoperative encapsulated effusion.Results Among the 56 patients underwent stageⅠrupture repair,35 cases of thoracotomy repair and 21 cases of endoscopic repair,and no death.No pleural hemorrhage,allergic reaction,fever and other adverse reac-tions occurred in the study group after operation.The incidence of postoperative encapsulated effusion and the rate of postoperative thoracic drainage in the study group were lower than those in the control group,and the time of chest tube removal,time of hospitalization and time of recovery of oral feeding in the study group were shorter than those in the control group,and the differences were statistically significant(P<0.05);there was no signif-icant difference in the time of antibiotic use between the two groups.Among the 56 patients,there were 29 cases of postoperative with encapsulated ef-fusion,and 27 cases without encapsulated effusion.The proportion of patients with encapsulated effusion from onset to operation time>12 h,es

关 键 词：尿激酶 自发性食管破裂 胸腔冲洗 

分 类 号：R655.4[医药卫生—外科学]