内科胸腔镜结合尿激酶治疗结核性包裹性胸腔积液的临床应用

Application research of medical thoracoscopy combined with urokinase in the treatment of encapsulated tuberculous pleural effusion

目的观察内科胸腔镜结合尿激酶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72例,随机分为治疗组(胸腔镜+尿激酶组)及对照组(尿激酶组),每组各36例,治疗组采用胸腔镜介入下治疗后再注入尿激酶治疗。对照组只于胸腔内注入尿激酶治疗。比较两组胸腔积液引流量及住院费用、住院天数,治疗两个月后再粘连情况、胸膜厚度以及肺功能改善情况。结果治疗组胸水纤维分隔粘连多房形成发生率5.6%,低于对照组为25.0%(P<0.05);治疗组胸腔积液引流量平均为(1100±250)ml,显著多于对照组的(700±180)ml(P<0.01);治疗组的FEV1/FVC及FVC(%)改善率、胸膜厚度改善值较对照组有显著差异(P<0.01)。结论内科胸腔镜结合尿激酶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。

Objective To investigate the effect of medical thoracoscopy combined with uroklnase on encapsulated tuberculous pleural effusion. Methods 72 patients with encapsulated tberculous pleural effusion were recruited and randomly divided into two groups, the treatment group （the medical thoracoscopy and urokinase group） and the control group （the urokinase group）. Each group had 36 cases. The treatment group treated by medical thoracoscopy and urokinase ; the control group was injected with the urokinase into the thoracic cavity. The total drainage volume, cost of hospitalization, Length of hospital stay, the pleural thickness and adhesion and pulmonary function were observed two months after treatment. Results The incidence of formation of fibrous septa or adhesion in the treatment group was 5.6%, which was significantly lower than that of 25.0% in the control group （ P 〈 0.05 ） ; The average drainage volume in the treatment group was （1100 ± 250） ml, which was statistically higher than that of （700± 180） ml in the control group （P 〈 0.01 ） ; The cost of hospitalization was in （3700 ± 500） the treatment group and （3550± 450） in the control group, and there was no significant difference （P 〉 0. 05 ） ; The hospital day was （ 10. 4 ± 2. 8） in the treatment group and （9.5 ± 2.5 ） in the control group, and there was no significant difference （ P 〉 0.05 ） ; Significant increases were in the Improvement rate of FEVl/FVC and FVC （ % ） and the Improvement of pleural thickness of in the treatment group compared with the controls （ P 〈 0. 01 ）. Conclusion The effect of the medical thoracoscopy combined with urokinase on the encapsulated tuberculous pleural effusion is very effective. It can significantly decrease formation of fibrous septa or adhesion, relieve pleural thickness and improve pulmonary function, but comparing with the control group, Length of hospital stay and cost of hospitalization are identical. It is a simple, cheap, effective, minimally invasive and safe method.