电子气管镜替代胸腔镜联合术后冲洗在急性脓胸中的应用研究

Clinical application of electronic bronchoscope replacing thoracoscope combined with postoperative rinse for patients with acute empyema

目的探讨电子气管镜替代胸腔镜联合术后冲洗在急性脓胸治疗中的临床应用效果。方法选择2012年1月至2016年1月期间我院收治的急性脓胸患者110例,依据手术方法不同分为电子气管镜组50例和胸腔镜组60例。电子气管镜组采用电子气管镜手术联合术后冲洗疗法,胸腔镜组采用胸腔镜手术联合术后冲洗疗法,并分别对两组患者的临床治疗情况,临床指标改善情况,并发症发生情况进行比较和分析。结果与胸腔镜组患者相比,电子气管镜组急性脓胸患者临床治疗的显效率(66.00%)、有效率(28.00%)、总有效率(94.00%)均与胸腔镜组相接近,差异均不具有显著性意义(χ~2=0.23,0.04,0.45,0.45;P>0.05);电子气管镜组急性脓胸患者的手术时间(80.96±17.65)min和住院时间(11.35±2.97)d,均明显缩短,住院费用(7634.12±1265.54)元明显减少,差异均具有显著性意义(t=3.75,4.01,4.33;P<0.05);电子气管镜组急性脓胸患者切口感染,持续肺部感染,持续包裹性积液等并发症总发生率8.00%略有上升,差异均不具有显著性意义(χ~2=0.18,0.02,0.56,0.07;P>0.05)。结论电子气管镜替代胸腔镜联合术后冲洗,在急性脓胸治疗中具有临床疗效好,操作简单,创伤性小,住院时间短,住院费用少等优势和特点,值得进一步的研究和推广。

Objective To probe into the clinical application effect of electronic bronchoscope replacing tho- racoscope combined with postoperative rinse for patients with acute empyema. Methods From January 2012 to Jan- uary 2016, 110 acute empyema patients were selected in our hospital. According to the different surgical methods, the patients were divided into the electronic bronchoscope group （ n = 50） and the thoracoscope group （ n = 60）. The electronic bronchoscope group was treated with electronic bronchoscopy surgery combined with postoperative rinse therapy, and the thoracoscope group was treated with thoracoscopy surgery combined with postoperative rinse therapy. The clinical treatment effect, improvement of clinical indicators and incidence of complications were compared and analyzed. Results The clinical significant efficiency was 66. 00%, the clinical efficiency was 28. 00%, and the to- tal efficiency was 94.00% in the electronic bronchoseope group, which were closed to the thoracoscope group （ χ2 = 0. 23, 0. 04, 0. 45, 0. 45 ; P 〉 0. 05 ）. The operation time were （80. 96 ± 17.65 ） min and duration of hospital stay were （ 11.35 ± 2. 97 ） d in the electronic bronchoscope group, which were obviously shorter than those in the thoraco- scope group. The hospitalization cost was （7634. 12 ± 1265.54） Yuan in the electronic bronehoscope group （t = 3.75, 4. 01,4. 33 ; P 〈 0. 05 ）. The total complication rate, included wound infection, persistent lung infection, and persistent encapsulated fluid, was 8.00% in the electronic bronchoscope group（ χ2 = 0. 18, 0. 02, 0. 56, 0. 07 ; P 〉0. 05 ）. Conclusion Electronic bronchoseope replacing thoracoscope combined with postoperative rinse has good clinical efficacy, simple operation, small trauma, shorter hospital stay and less hospitalization cost advantages and features in the treatment of acute empyema patients, which is worthy of further research and extension.