局麻下胸腔镜介入治疗结核性包裹性胸腔积液的疗效观察

Effect obveration by the medical thoracoscopy in treating encapsulated tberculous pleural effusion

目的观察内科胸腔镜治疗结核性包裹性胸腔积液的疗效。方法结核性包裹性胸腔积液病人126例,随机分为治疗组(胸腔镜组)及对照组(尿激酶组),每组各63例,胸腔镜组采用胸腔镜介入下治疗,对照组于胸腔内注入尿激酶10万U。比较两组胸腔积液胸腔粘连、引流量及胸膜厚度,治疗后肺功能以及住院费用。结果治疗组胸水纤维分隔粘连多房形成发生率7.9%,而对照组为34.9%(P<0.05);胸腔镜组胸腔积液引流量平均为(2500±450)ml,显著多于对照组的(1500±320)ml(P<0.01);治疗组胸膜厚度为(1.15±0.32)mm,显著低于对照组(1.97±0.45)mm(P<0.01);肺功能治疗组FEV1(%)为89.8±1.8,对照组82.2±2.2;治疗组FVC(%)96.1±2.3,对照组88.3±2.5(P<0.01);住院天数治疗组8.0±3,对照组7.5±2(P>0.05);住院费用治疗组2700±500,对照组2500±450。结论内科胸腔镜治疗包裹性胸腔积液,可以显著减少胸腔分隔,粘连,多房形成,减轻胸膜肥厚,以及改善肺功能,而住院天数费用较传统方法无明显增加。

Objective To investigate the effect by the medical thuracoseopy to cure encapsulated tbereulous pleural effusion. Methods 126 eases patients who suffering from the tuberculose encapsulated thoreaeie cavity hydrops were randomly divided into two groups ： the treatment group （ the medical thoracoseopy） and the control group （ the abbokinase group）. There were 63 eases in each group. The treatment group used medical thoracoscopy. The control group was injected by the abbokinase 0. 1 million U into the thoracic cavity. The data of the drainage quantity and the thickness of the thoracic cavity, post-treatment, pulmonary function and the cost of hospitalization were compared. Results The incidence rate formation of fibrous septa or adhesion in the treatment group was 7.9% , and in the control group 34.9 %. The average drainage quantity of the thoraeoseopy group was （2500 ± 450） ml, which was statistically higher than the eontraposition group（ 1500 ±320 ） ml, （ P 〈 0.01 ）. The thickness of the thoracic： eavity in the medical thoraeoseopy was （ 1.15 ± 0. 32 ） ram, which was statistically lower than the control group （ 1.97 ± 0.45 ） mm （ P 〈 0.01 ）. There was a significant increased in FEV1 （ % ） and FVC （%）in the treatment group compared with the controls（ P 〈 0. 01 ）. The cost of hospitalization was semblable in the treatment group （ 2700 ± 500 ） compared with the controls （ 2650 ± 450） （ P 〉 0. 05 ）. The hospital day was uniform in the treatment group （ 8.0 ± 3 ） compared with the controls （ 7.5 ± 2 ） （ P 〉 0.05 ）. Conclusion The effect by the medical thoraeoseopy to cure the encapsulated tberculous pleural effusion is very clear. It can significantly decrease formation of fibrous septa or adhesion; so as to relieve pleural thickness and improve pulmonary function. But there was no group difference in hospital day and expense.