结核性包裹性胸膜炎治疗方法探讨

Study of treatment of tuberculous encapsulated pleurisy

目的探讨治疗结核性包裹性胸膜炎的新方法。方法将选入的189例包裹性胸膜炎患者用随机数字表法分为3组：A组65例，采用中心静脉导管置入胸膜腔内引流胸腔积液，每Et通过引流管注入尿激酶10万U；B组66例，只采用中心静脉导管置入胸膜腔内引流胸腔积液；C组58例，每周2—3次用常规胸穿方法抽胸腔积液。3组患者的化疗方案均为2HREZ／10HR。比较3组临床疗效。结果治疗2个月时显效率、有效率及总有效率A组分别为89．2％（58例）、9．2％（6例）、98．5％（64例）；B组分别为81．8％（54例）、12．1％（8例）、93．9％（63例）；C组分别为8．6％（5例）、58．6％（34例）、67．2％（39例）。治疗12个月时A、B、C3组的总有效率分别为100％、90．9％、82．7％。A组总有效率与B、C两组比较差异有统计学意义（P〈0．05）。结论用中心静脉导管胸膜腔内置入加注入尿激酶是一种治疗包裹性胸膜炎的理想方法。

Objective To explore a new therapy of tuberculous encapsulated pleurisy. Method The encapsulated tuberculous encysted pleurisy patients were divided into 3 groups ： group A had central venous catheter for pleural cavity drainage of pleural effusion and a daily injection of urokinase 100 000 U through the drainage tube. Group B （66 patients） were treated by a central venous catheter for drainage of pleural fluid only. Group C of 58 ea- ses got pleural puncture and extraction of conventional pleural effusion 2 or 3 times a week. Three groups of patients got the same chemotherapy as 2HREZ/10HR. Results After two months＇treatment, the effective rate, markedly effective rate and total effective rate was 89.2% ,9.2% and 98.5% （ group A） ; 81.8% , 12.1% ,93.9% （ Group B） was and 8.6% , 58.6% , 67.2% in group C. After twelve months＇ treatment ,the total effective rate of group A was higher than that of group B and group C. Conclusion Central venous catheter implantation plus intrapleural urokinase is effective for treating encysted pleurisy.