胸腔镜下冷冻联合尿激酶注入治疗结核性包裹性胸腔积液的疗效观察

Thoracoscopy and the urokinase injection in the treatment of tuberculous encapsulated pleural effusion

目的探讨胸腔镜下冷冻治疗联合尿激酶胸膜腔注入治疗结核性包裹性胸腔积液的临床价值。方法回顾性分析2013年3月—2016年3月咸阳市中心医院呼吸内科收治的结核性包裹性胸膜炎64例,按治疗方法不同分为治疗组及对照组各32例。治疗组采用胸腔镜下冷冻治疗清除胸腔内纤维包裹病变,再联合胸膜腔内注入尿激酶融化残留的纤维组织;对照组单纯采用胸腔闭式引流术置管联合尿激酶胸膜腔内注射治疗。比较2组的临床症状改善情况,行影像学检查胸膜粘连包裹缓解程度,观察并发症的发生率。结果治疗组症状总改善率100%,明显高于对照组71.92%,差异有统计学意义（χ^2=10.473,P〈0.05）;治疗组胸膜粘连包裹缓解总有效率为100%,明显高于对照组的71.9%,差异有统计学意义（χ^2=89.061,P〈0.05）。影像学观察胸腔积液吸收及胸膜腔纤维光带分隔融化,治疗组并发症发生率为9.4%,对照组为6.3%,2组比较差异无统计学意义（χ^2=0.587,P〉0.05）。结论胸腔镜下冷冻治疗可在直视下对纤维增生病变进行清除,联合尿激酶膜腔内注入可进一步清除残留纤维包裹带,减轻胸膜肥厚,控制胸腔积液产生,疗效满意,值得临床推广应用。

Objective To investigate the clinical value of the treatment of tuberculous encapsulated pleural effusion by the combination of the internal medicine and the treatment of the pleural cavity.Methods Retrospective analysis of tuberculous pleurisy from March 2013 to March 2016 in Xianyang Central Hospital of respiratory medicine from 64 cases,according to the different treatment methods were divided into treatment group and control group of 32 cases.In the treatment group,the treatment group was treated by endoscopic surgery to remove the fibrous tissue in the thoracic cavity,and then the fibrous tissue was injected into the pleural cavity.Patients in the control group were treated by thoracic closed drainage combined with urokinase.The clinical symptoms of the 2 groups were compared,and the degree of remission of pleural adhesion was observed,and the incidence of complications was observed.Results In the treatment group,the total improvement rate of symptoms was 100%,which higher than the control group＇s 71.92%,the difference was statistically significant（χ^2= 10.473,P〈0.05）;the treatment group of pleural adhesions wrapped remission rate was 100%,significantly higher than the control group＇s 71.9%,the difference was statistically significant（χ^2=89.061,P〈0.05）.The imaging observation of pleural effusion and pleural cavity fiber band separated melting treatment group the complication rate was 9.4%,6.3%in the control group,the 2 groups had no statistically significant difference（χ^2=0.587,P〉0.05）.Conclusion Endoscopic cryotherapy can under the direct of fibrous hyperplasia lesions were removed,combined with urokinase injection into the cavity can further remove residual film fiber wrapped with ease,pleural thickening,pleural effusion controlled,satisfactory curative effect,it is worthy of clinical application.