单操作孔胸腔镜逆行胸膜剥脱术治疗结核性局限性包裹性脓胸

Treatment of limitation encapsulated tuberculous empyema with retrograde pleural stripping operation via single-port video-assisted thoracoscopic surgery

目的探讨在单操作孔胸腔镜下以逆行胸膜剥脱术的方式治疗结核性局限性包裹性脓胸的可行性。方法2015年1月至2016年6月，共35例结核性局限性包裹性脓胸患者在我院行单操作孔胸腔镜胸膜纤维板逆行剥脱术。统计分析术中出血量、手术时间、术后引流管留置时间、手术前后肺功能变化等指标。计量资料以“-χ±S”表示，计量资料的比较使用t检验，以P〈O．05为差异有统计学意义。结果患者均在全胸腔镜下一期成功完成手术，手术切口长度平均（4．71±0．80）cm，手术时间平均（164．20±28．01）min，术中出血量平均（298．97±74．24）ml；切口全部一期愈合，住院时间平均（15．80±4．28）d。手术前与术后1个月肺功能用力肺活量（FVC）[（2．35±0．27）L、（3．36±0．20）L]、第1秒用力肺活量（FEV1）[（2．13±0．20）L、（3．04±0．17）L]、肺总量（TLC）[（4．99±0．70）L、（5．51±0．51）L3差异均有统计学意义（￡值分别为17．68、3．43、25．53，P值均〈0．05），说明治疗后较治疗前患者肺功能得到了明显改善。本组患者术后经6个月随访，未发现结核病复发患者。结论单操作孔胸腔镜下逆行胸膜剥脱术治疗结核性局限性包裹性脓胸能达到彻底清除病灶、减少术中出血、减小切口损伤、提高术后肺功能的目的。

Objective To explore the feasibility in treatment of limitation encapsulated tuberculous empyema with retrograde pleural stripping operation via single-port video-assisted thoracoscopic surgery. Methods We analyzed retrospectively the treatment by retrograde pleural stripping operation via single-port video-assisted thoracoscopic surgery in 35 cases with limitation encapsulated tuberculous empyema admitted in our hospital during Jan. 2015 to Jun. 2016. The intraoperative bleeding, operation time, postoperative drainage extubation time and pulmonary function before and after operation were analyzed. The measurement data were expressed as ＂-χ±s＂ and analyzed using t test. P〈0.05 was considered statistically significant. Results All patients underwent completely via thoracoscopy. The average length of the incision was （4. 71±0.80） cm, the average operation time was （164. 20±28.01） rain, the average intraoperative bleeding was （298. 97 ± 74.24） ml. All the incisions were healed by first intention. The average hospitalization time was （15.80 ± 4.28） days. The differences before and after operation （one month） in FVC （（2.35±0.27） L vs. （3.36±0.20） L）, FEV1 （（2.13±0.20） L vs. （3.04±0.17） L）, TLC （（4.99±0.70） L vs. （5.51±0.51） L） were statistically significant （t=17.68, 3.43 and 25.53, P〈0.05）. It in- dicated that the pulmonary function was improved obviously after operation. No case was relapsed during the follow up for 6 months. Conclusion The treatment of limitation encapsulated tuberculous empyema with retrograde pleu- ral stripping operation via single-port video-assisted thoracoscopic surgery can achieve the objectives of lesion de- bridement, less intraoperative bleeding, less wound injury, and the postoperative pulmonary function improvement.