单孔局部麻醉下软硬支气管镜相结合治疗包裹性结核性胸腔积液

Therapy of loculated tuberculous pleurisy under local anesthesia through single port by fiberoptic bronchoscope combined rigid bronchoscope

目的在局部麻醉(局麻)单孔下利用软硬支气管镜相结合对早期包裹性结核性胸腔积液患者进行治疗,探讨其治疗效果。方法回顾分析2009年7月～2010年7月经单孔局部麻醉下利用软硬支气管镜相结合治疗的早期结核性包裹性积液患者15例,均为在外院多次行胸腔穿刺或引流的患者,胸片示胸腔积液形成包裹,B超提示胸腔内纤维素形成,采用局麻单孔下软硬支气管镜相结合的办法,将积液充分的吸出和打断,钳出纤维素,术后尿激酶冲洗及充分引流。结果 15例患者中12例患者肺完全复张,3例有效,无感染、肺水肿及出血,费用低,平均住院天数8d。结论单孔局部麻醉下软硬支气管镜相结合治疗早期包裹性结核性胸腔积液是一项安全、有效、费用低廉的治疗方法,可避免这一类患者病情加重而需要开胸治疗。

[Objective] To investigate the effect of the treatment for loculated tuberculous pleurisy under local anesthesia through one port by fiberoptic bronchoscope combined rigid bronchoscope.[Methods] Fifteen early loculated tuberculous pleurisy patients（male,10 female,5） from 2009,7 to 2010,7 treated by fiberoptic bronchoscope combined rigid bronchoscope under local anesthesia through single port were analyzed retrospectively.The patients were shifted from other hospital.They were treated by repeated thoracentesis or conventional chest tube drainage.The chest X-ray,B-ultrasound documented the loculated tuberculous pleurisy.Thoracoscopy successfully drained the remaining pleural effusion by destroying the fibrinous septal formation in the pleural space.The patients were irrigated by urokinase after operation and drainage.[Results] The lung were totally expanded in 12 patients of 15,3 of 15 were effective.There were no infection,pneumonedema and bleeding.The cost was low,and the mean hospital stay was 8.[Conclusions] The treatment of early loculated tuberculous pleurisy under local anesthesia through one port by fiberoptic bronchoscope combined rigid bronchoscope is safety,effective,and with low cost.It can prevent those patients from thoracotomy.