37例难治性结核性胸膜炎临床分析

目的探讨难治性结核性胸膜炎的临床特点及防治措施。方法对37例难治性结核性胸膜炎的临床资料进行回顾性分析。结果 37例患者病史均在2个月以上,多数已经形成包裹性积液。入院后均进行了规律的抗结核治疗,无禁忌证者辅以激素治疗。对患侧胸腔积液2.8cm以上试穿能抽出积液者32例行胸腔置管持续引流及胸腔内注射尿激酶治疗,其中有5例为脓气胸者用蘑菇头胸腔闭式引流。2个月后有19例包裹积液完全吸收,7例形成轻度胸膜肥厚粘连。有6例患者经内科治疗3个月积液吸收不明显,包裹面积大,致患侧肋间隙变窄,胸腔塌陷,故转入外科行胸腔镜及手术治疗。其他5例不能抽液者辅以中药治疗治愈。结论难治性结核性胸膜炎行规律抗结核治疗,同时重视包括胸腔置管引流、中药等治疗方法的综合应用可提高治疗效果。

Objective To study and discuss the clinical characteristic and the prevention and treat measures of tuberculous pleuritis which is difficult to treat.Methods The clinical data of 37 cases with tuberculous pleuritis which is difficult to treat was retrospectively analyzed.Results 37 cases had been ill for 2 months and encysted pleuritis had formed.37 cases received regular antituberculous therapy.The cases without contraindication were treated with cortin as the assistant method.32 cases with beyond 2.8cm pleural effusion were treated with chest shut type drainage and urokinas was injected into pleural cavity.Thereinto,5 cases with pyothorax and pneumothorax were treated with atresic drainage with thick tube.2 months later,encysted pleuritis of 19 cases were absorbed completely and pleura pachismus and conglutination formed in 7 cases.The treat effects in 6 cases were bad.They were treated with thoracic mirror or operation in surgery.In addition,5 cases could not treated with liquid drainage were cured with Chinese traditional medicine.Conclusion Regular antituberculous therapy and various methods including chest shut type drainage can increase the curative effect to tuberculous pleuritis difficultto cure.