电视胸腔镜与开胸手术治疗早期结核性包裹性胸膜炎的病例对照研究

Video-assisted Thoracoscopy versus Thoracotomy for Encapsulated Tuberculous Pleurisy:A Case Control Study

目的 对比电视胸腔镜与开胸手术治疗结核性包裹性胸膜炎的临床疗效。方法 回顾性分析2013年1-12月我院病史3个月以内的包裹性结核性胸膜炎进行手术99例患者的临床资料。据手术方式分为两组：电视胸腔镜组,行电视胸腔镜胸膜剥脱术,49例男35例、女14例,平均年龄（26.78±9.36）岁;开胸组,行常规开胸胸膜剥脱术,50例男31例、女19例,平均年龄（31.84±11.08）岁。电视胸腔镜组术前43例行胸腔置管引流,引流量（659.08±969.29）ml,开胸组48例行胸腔置管引流,引流量为（919.03±129.97）ml。比较两组临床效果。结果电视胸腔镜组患者均在完全胸腔镜下完成,无中转开胸。电视胸腔镜组手术时间和胸腔引流管留置时间比开胸组短[（103.00±53.04）min vs.（127.06±51.60）min,P〈0.01（3.02±0.83）d vs.（3.94±1.25）d,P〈0.01]。随访时间6个月,胸腔镜组和开胸组第一秒用力呼气容积（FEV_1）[（2.83±0.64）L vs.（2.25±0.64）L,P〈0.01],用力肺活量（FVC）[（3.02±0.72）Lvs.（2.57±0.79）L,P〈0.05],最大自主通气量（MVV）[（93.90±15.86）L vs.（80.34±17.06）,P〈0.01]。结论在3个月以内病史的包裹性胸膜炎患者可以行胸腔镜手术,且临床效果优于开胸手术。

Objective To compare the clinical efficacy of video-assisted thoracoscopy and thoracotomy for the treatment of encapsulated tuberculous pleurisy. Methods We retrospectively analyzed the clinical data of 99 patients who had underwent surgery for encapsulated tuberculous pleurisy within 3 months of disease onset in our hospital from January through December 2013. Based on the surgical mode, patients were assigned to a video-assisted thoracoscopy group, including 49 patients （35 males and 14 females, a mean age of 26.78＋9.36 years）, to receive videoassisted thoracoscopic pleurectomy; or a thoracotomy group, including 50 patients （31 males and 19 females, a mean age of 31.84±11.08 years）, to receive conventional thoracotomic pleurectomy. The first 43 patients in the video-assisted thoracoscopy group received thoracic catheter drainage, with the drainage volume of 659.08_＋969.29 ml; the first 48 patients in the thoracotomy group received thoracic catheter drainage, with the drainage volume of 919.03±129.97 ml. The clinical effects were compared between the two groups. Results All the patients in the video-assisted thoracoscopy group completed thoracoscopy without conversion to thoracotomy. The surgery duration and postoperative intubation time were shorter in the video-assisted thoracoscopy group than those in the thoracotomy group （surgery duration： 103.00±53.04 rain vs. 127.06±51.60 min, P〈0.01; postoperative intubation time 3.02±0.83 d vs. 3.94＋1.25 d, P〈0.01）. At the end of 6 months of follow-up, the forced expiratory volume in one second （FEV1） was 2.83±0.64 L in the thoracoscopy group and 2.25±0.64 L in the thoracotomy group （P〈0.01）; forced vital capacity （FVC） was 3.02±0.72 L in the thoracoscopy group and 2.57±0.79 L in the thoracotomy group （P〈0.05）; and maximal voluntary ventilation （MVV） was 93.90±15.86 L in the thoracoscopy group and 80.34＋17.06 L in the thoracotomy group （P〈0.01）. Conclusion Thoracoscopic surgery is feasible for patients with encapsulated pleurisy within 3 months of onset. Furthermore video-assisted thoraco- scopy will be superior to thoracotomy.