胸腔镜手术后置管冲洗治疗早期结核性包裹性脓胸38例分析

Effectiveness analysis of catheter flushing treatment after thoracoscopic surgery in 38 patients with early stage tubercu- lous encapsulated empyema

对湖南省结核病防治所外科2015年1月至2015年8月收治的，经临床确诊的38例早期结核性包裹性脓胸患者，行胸腔镜胸膜腔廓清术后置管胸膜腔内注药，方法为“异烟肼0．3g＋阿米卡星0．4g”与“生理盐水100ml＋尿激酶25万U”隔日交替冲洗治疗。作者对此类患者的手术适应证及本组38例患者的相关手术情况进行分析，结果显示，38例患者全组手术过程顺利，无切口感染。术后均顺利拔管，复查均无再发包裹性胸腔积液，术后胸腔内残腔形成6例。术后随访1-1．5年，均未复发。无胸腔内感染，胸膜瘘等不良反应。说明对于早期包裹性结核性脓胸患者，胸腔镜胸膜腔廓清术联合置管胸腔内注药冲洗的临床治疗效果确切。

Thirty-eight patients with early stage tuberculous encapsulated empyema, who were diagnosed and hospitalized at our department of the Hunan Provincial Tuberculosis （TB） Dispensary, received thoracoscopic sur- gery and then were treated by catheter flushing with isoniazid 0. 3 g＋amikacin 0. 4 g or normal saline 100 ml＋Uro- kinase 250 000 U. every other day. We analyzed the indications of the surgery and the situation of 38 patients after surgery. The results showed that the operations were successful in all 38 patients and the patients recovered smoo- thly without infection. Recurrence of encapsulated pleural effusion was not found in all 38 patients, while thoracic residual cavity after operation was found in 6 patients. All patients were followed up for I to 1.5 years and no relapse. Pleural infection or pleural fistula or other adverse reactions did not happen. As for the patients with encapsulated tuberculous empyema, the clinical treatment effectiveness of thoracoscopic surgery＋catheter flushing with anti-TB drugs after surgery is clear.