尿激酶治疗结核性包裹性胸积液后外科手术治疗的疗效分析

Effect of surgical treatment of tuberculous encapsulated pleural effusion after the treatment of urokinase

目的探讨在结核性包裹性胸积液疾病治疗中如何选择胸腔内注入尿激酶与外科手术治疗。方法分析我院651例诊断结核性包裹性胸积液病例,在入院后予常规抗痨治疗并予胸腔内注入尿激酶治疗,对有效组与效果不佳再转入外科行胸腔纤维板剥脱术治疗的手术组的疗效进行对比分析。结果两组病例的发病病程、复发率比较无明显差异(P>0.05),在体查及B超、CT检查、胸腔穿刺或置管后肺能否复张比较有明显差异(P<0.05)。结论在体查、B超和CT检查有阳性结果、胸腔穿刺或置管后肺不能复张的病例选择外科手术治疗效果较好,胸膜纤维板剥脱术仍是治疗胸膜增厚的结核性包裹性胸积液的有效方法。

Objective To investigate how to choose intrapleural urokinase or surgery in the treatment of tu berculous encapsulated pleural effusion. Methods The clinical data of 651 patients with tuberculous encapsulated pleural effusion were retrospectively analyzed. After a anti-tuberculosis treatment combined with intrapleural urokinase injection, we compared and analyzed the results of the effective treatment group and the ineffective treatment groupwhich were switched to pleural decortication reatment. Results There was no significant difference in disease course and recurrence （ P 〉 0. 05 ） , but there existed certain differences in physical examination, ultrasound, CT examina tion, re-expansion extent of lung （ P 〈 0. 05 ）. Conclusion Surgical treatment is more effective in the treatment of patients with a positive result of physical examination and B-ultrasound and CT, a failure of re-expansion of lung after the pleural puncture or catheter. Pleural decortication is an effective treatment for the cases of tuberculous encapsula ted pleural effusion with pleural thickening.