碘酊全胸膜固定术治疗继发性气胸的价值研究

Control study of complete pleurodesis by iodine tincture in treatment of secondary spontaneous pneumothorax

目的探讨碘酊作为化学性胸膜固定硬化剂在继发性自发性气胸(SSP)治疗中的价值。方法 2005年10月至2015年10月,选择可手术治疗的SSP患者85例,随机分为A组43例,B组42例。2组患者均行开胸肺大疱切除术,A组采用2%和1%浓度的碘酊分别对壁层、脏层胸膜进行胸膜固定术(PD),B组采用滑石粉进行PD。比较2组病例术后胸腔引流总量,胸管留置时间,术后不良反应发生率,术后并发症,远期复发率。结果 2组间胸腔引流总量,胸管留置时间,术后漏气>5 d,肺不张,肺感染,胸顶残腔,远期复发率等比较差异无统计学意义(P>0.05)。A组发热,胸痛的发生率及胸腔包裹积液的并发率比B组少,差异有统计学意义(P<0.05)。结论碘酊作为化学性胸膜固定硬化剂在预防SSP术后的远期复发方面与滑石粉效果相当,同样显著,并且比滑石粉不良反应及并发症发生率低。

Objective To explore the application value of iodine tincture as a chemical pleura hardener in treatment of secondary spontaneous pneumothorax(SSP).Methods A total of 85 patients with SSP, who underwnt surgical treatment in our hospital from October 2005 to October 2015, were randomly divided into group A(n=43) and group B(n=42). The patients in both groups underwent thoracotomy and resection of pulmonary bulla. The patients in group A underwent PD for parietal pleura and visceral pleura with 2% and 1% iodine tincture,however,the patients in group B underwent PD with talcum powder. After operation,the volume of total chest drainage, the indwelling time of drainage tube, the incidence of adverse reactions,the postoperative complications and the long term recurrence rate were observed and compared between the two groups.Results There were no statistically significant differences in the volume of total chest drainage, the indwelling time of drainage tube, the postoperative air leakage(>5 d), pulmonary atelectasis, the pulmonary infection, chest residual cavity, and the long-term recurrence rate between the two groups(P>0.05). The incidence rates of fever and chest pain, and the complication rate of pleural effusion in group A were significantly lower than those in group B(P<0.05).Conclusion Iodine tincture as a chemical pleurodesis hardener, has equivalent and remarkable effects with talcum powder in preventing the long-term recurrence of SSP after operation,moreover, the incidence of adverse reactions and complications of iodine tincture is significantly lower than that of talcum powder.