胸腔镜胸膜固定术治疗大量恶性胸腔积液的可行性及安全性

Feasibility and safety of thoracoscopic pleural fixation in the treatment of malignant pleural effusion

目的研究分析胸腔镜胸膜固定术治疗恶性胸腔积液的可行性及安全性。方法回顾性分析80例恶性胸腔积液患者的临床资料，根据治疗方式分为观察组和对照组，每组40例。观察组采用胸腔镜胸膜固定术治疗，对照组采用胸腔闭式引流治疗。分析比较两组患者胸水控制情况、胸水检查中胸水蛋白、白细胞计数、乳酸脱氢酶水平及肿瘤患者KPS评分。结果观察组胸水控制总有效率高于对照组，差异有统计学意义（P〈0.05）。手术前两组患者胸水蛋白、白细胞计数、乳酸脱氢酶水平比较差异未见统计学意义（P〉0.05）；术后两组胸水检查指标均低于治疗前，且观察组降低幅度大于对照组，差异有统计学意义（P〈0.05）。术前，两组患者KPS评分比较差异未见统计学意义（P〉0.05）；术后两组KPS评分均高于治疗前，且观察组KPS评分升高幅度大于对照组，差异有统计学意义（P〈0.05）。结论胸腔镜胸膜固定术治疗恶性胸膜积液具有更好的疗效及安全性，能够有效提高胸水控制有效率并减少蛋白析出，提高肿瘤患者术后生活质量。

ObjectiveTo investigate the feasibility and safety of thoracoscopic pleura fixation in the treatment of malignant pleural effusion.MethodsThe clinical data of 80 patients with malignant pleural effusion were retrospectively analyzed, and patients were divided into observation group and control group according to treatment methods, with 40 cases in each group. Patients in observation group were treated by thoracoscopic pleura fixation, and patients in control group were treated by closed thoracic drainage. The pleural effusion control condition, pleural effusion protein, white blood cell （WBC） count, lactate dehydrogenase level and the Karnofsky （KPS） score were compared between the two groups.ResultsThe total effective rate of pleural effusion control in observation group was higher than that in control group, the difference was statistically significant （P〈0.05）. There was no significant difference in the level of quantitative detection of pleural effusion protein, WBC, lactate dehydrogenase in the two groups before treatment （P〉0.05）; after treatment, the indexes of all pleural effusion were lower than those before treatment, and the decrease of observation group was greater than that of control group, the difference was statistically significant （P〈0.05）. There was no significant difference in KPS score between the two groups before treatment （P〉0.05）; after treatment, the KPS scores of the two groups were all higher than those before treatment, and the increase of the KPS score in observation group was higher than that in control group, the difference was statistically significant （P〈0.05）.ConclusionsThoracoscopic pleura fixation has a better efficacy and safety in the treatment of malignant pleural effusion. It can improve the efficiency of the control of hydrothorax, reduce the precipitation of protein and improve the quality of life.