局麻下胸腔镜治疗结核性包裹性胸膜炎的疗效分析

Efficacy of local anesthesia-assisted thoracoscopic treatment of tuberculous encysted pleurisy

目的探讨局麻下胸腔镜治疗结核性包裹性胸膜炎的疗效。方法选取61例结核性包裹性胸膜炎患者,随机分为胸腔镜组及对照组。胸腔镜组给予局麻下胸腔镜治疗,对照组给予反复胸腔穿刺并胸腔内注入尿激酶治疗。比较两组治疗后胸闷、气短症状消失情况,胸液消失及胸腔分隔包裹、粘连情况,壁层胸膜厚度及肺功能的变化。结果治疗后2个月胸腔镜组胸闷气短症状消失率、胸液消失率、肺功能用力肺活量占预计值百分比(FVC%)、补呼气量占预计值百分比(ERV%)值均高于对照组,而胸膜厚度及胸腔纤维分隔、多房形成的发生率均低于对照组,差异均有显著性(P<0.05)。治疗中、后胸腔镜组无严重并发症发生。结论局麻下胸腔镜治疗结核性包裹性胸膜炎疗效好、安全、简便、损伤小,并发症发生率低,且可同时获取病理诊断,值得临床推广。

[Objective] To discuss the efficacy under local anesthesia-assisted thoracoscopic treatment of tuberculous encysted pleurisy.[Methods] Select 61 patients showed pleural package,hypertrophy,adhesion of tuberculous encysted pleurisy and randomly divided into thoracoscopic group and control group.Thoracoscopic group received thoracoscopic treatment under local anesthesia,the control group were given repeated thoracentesis and intrapleural urokinase.To compare chest distress,short breath and pleural effusion disappeared;pleural adhesions,separate parcels;parietal pleural thickness;changes in lung function in the two groups after treatment.[Results] 2 months after treatment,the rate of disappearance of chest distress or short breath and pleural effusion,FVC%,ERV% in thoracoscopy group was higher;while pleural adhesions,parcels and parietal pleural thickness were lower than control groups,the differences were statistically significant （P〈0.05）.Thoracoscopic group had no serious complications both during and after treatment.[Conclusions] Under local anesthesia-assisted thoracoscopic treatment of tuberculous encysted pleurisy had good efficacy.It is safe,simple,little damage,low complication rate,and can also obtain pathological diagnosis,is worthy of promotion.