胸腔镜冷冻治疗纤维黏连为主型结核性胸腔积液的临床观察

Efficacy of thoracoscopic cryotherapy for fibronectin predominant of tuberculous pleurisy effusion

目的探讨经胸腔镜微创冷冻治疗结核性胸腔积液形成纤维黏连及壁层胸膜结核结节的临床疗效。方法对38例结核性胸腔积液形成纤维黏连的患者通过内科胸腔镜微创检查并对纤维黏连带采用冷冻探针清除,并对壁层胸膜结核结节进行冻融治疗。结果患者胸腔内见大量纤维黏连形成,采用冷冻探针进行冻切后可清除胸腔内病变,壁层胸膜结核结节通过冻融治疗后迅速坏死。经治疗后患者症状改善,胸腔积液吸收明显。显效:12例(31.6%);有效24例(63.2%),无效2例(5.3%),总有效率94.7%。结论内科胸腔镜能及时发现胸腔纤维黏连,并可以在直视下对病变进行清除,冷冻治疗是内镜介入治疗胸膜病变的有效方法,且安全。

Objective To explore clinical effect of micro-invasive cryotherapy via medical thoracoscopy on fibronectin predominant of puberculous pleurisy effusion. Methods 38 cases with fibronectin predominant of puber- culous pleurisy effusion were enrolled, and they all received the treatment with micro-invasive detection via medical thoracoscopy, and elimination of intrathoracic fibronectin encapsulated lesions by cryo-probe, and freeze thawing treatment for parietal pleura tubercles. Results All the patients had a large amount of intrathoracic encapsulated fi- bronectin adhesion. The cryo-probe elimination method could eliminate the intrathoracic lesion. The therapy signifi- cantly improved their symptoms and made the hydrothorax reduce obviously. There were 12 cases （31.6%） with marked effect, 24 （63.2%） with effect, and 2 （5.3%） with no effect. The total efficiency was 94. 7%. Conclu- sion The application of medical thoracoscopy can timely find intrathoracic fibronectin encapsulated lesion, and re- section of the lesion could be done under direct vision with thoracoscope. The cryotherapy is another effective and safe method to treat pleural lesions, which is worthy of wide popularization.