改良单切口手术治疗外穿性结核性脓胸的疗效观察

Observation on curative effect of modified single incision operation on perforated tuberculous empyema

目的探讨改良单切口手术治疗外穿性结核性脓胸的临床疗效。方法选取河南省胸科医院2010年3月至2018年5月间行手术治疗的外穿性结核性脓胸患者共386例,年龄(中位数),13~68岁(35.62±10.3岁),其中,男282例(73.1%),女例104例(26.9%)。采用改良单切口手术的189例患者作为观察组,采用传统手术切口的197例患者为对照组。对比分析两组患者的如下指标:切口长度、切口数量、手术时间、术中出血量、术后疼痛评分、术后引流量、置引流管时间、切口一期愈合率、术后住院时间、术后并发症发生率等,对治疗效果进行评价。结果两组均顺利完成手术,传统组、改良组在手术时间[(120±55)min vs.(100±47)min]、切口长度[(12.5±3.6)cm vs.(8.6±2.9)cm]、术后住院时间[(15.7±4.7)d vs.(12.1±3.0)d]、术后24h疼痛评分[(4.17±1.06)分vs.(2.01±0.78)分]等方面差异均有统计学意义(P<0.05);肺部感染[2例vs.2例]、复发[1例vs.0例]及支气管胸膜瘘[0例vs.0例]差异均无统计学意义(P>0.05)。结论改良单切口手术治疗外穿性结核性脓胸,在严格术前准备及评估后,该手术方式在治疗外穿性结核性脓胸上具有切口小、无需加压包扎、术后疼痛评分低、术后并发症低及住院时间短等优点。在规范抗痨治疗的基础上,彻底清除病灶、充分切口引流及胸腔引流,均能收到良好效果。

Objective to investigate the clinical effect of modified single incision in the treatment of extraneous tuberculous empyema.Methods A total of 386 patients with perforated tuberculous empyema who underwent surgery in henan chest hospital between March 2010 and May 2018 were selected.Age(median),13~68 years(35.6±10.3 years).There were 282 males(73.1%)and 104 females(26.9%).189 patients with modified single incision surgery were selected as the observation group and 197 patients with traditional incision surgery as the control group.The following indexes were compared and analyzed for the patients in the two groups:incision length,incision number,operation time,intraoperative blood loss,postoperative pain score,postoperative drainage volume,catheter duration,postoperative hospital stay,postoperative complication incidence,etc.,to evaluate the therapeutic effect.Results Both groups completed the operation successfully.The operation time of the traditional group and the improved group[(120±55)min vs.(100±47)min]、Incision length[12.5±3.6 cm vs.(8.6±2.9)cm]、Duration of postoperative hospital stay[(15.7±4.7)d vs.(12.1±3.0)d]、24 h postoperative pain score[(4.17±1.06)points vs.(2.01±0.78)points]was statistically significant(P<0.05).Pulmonary infection[2 cases vs.2 cases],recurrence[1 cases vs.0 cases]and bronchopleural fistula[0 cases]had no statistical significance(P>0.05).Conclusion Modified single incision surgery for external penetrating tuberculous empyema is suitable for all stages of patients.After strict preoperative preparation and evaluation,this surgical method has the advantages of small incision,low postoperative pain score,low postoperative complications and short hospital stay.On the basis of standardized anti-tuberculosis treatment,complete removal of lesions,adequate incision drainage and chest drainage can achieve good results,which is worth promoting.