Ⅲ期结核性脓胸胸廓塌陷程度的评估及术后胸廓形态改善相关影响因素分析

Evaluation of the degree of thoracic collapse in stageⅢtuberculous empyema and analysis of the factors related to improvement of thoracic collapse after surgery

目的寻找Ⅲ期结核性脓胸胸廓塌陷程度的客观评价方法,分析Ⅲ期结核性脓胸术后胸廓塌陷改善的相关影响因素。方法回顾性分析2018年2月至2021年8月在成都公共卫生临床中心接受手术治疗的Ⅲ期结核性脓胸患者,于术后1、3、6、12个月分期行胸部CT检查,经隆突及剑突平面分别测量患侧及健侧骨性胸廓内缘半周长并计算“胸廓塌陷指数”,根据术后12个月随访时“胸廓塌陷改善百分比”是否≥4%,将研究人群分为胸廓塌陷显著改善组及胸廓塌陷未显著改善组。分析影响术后胸廓塌陷显著改善的因素。结果研究共纳入患者62例,其中男46例、女16例,平均年龄(27.58±12.55)岁。在隆突及剑突平面术后各随访时段胸廓塌陷指数均显著小于术前(P<0.05),且整体呈逐渐下降趋势,至术后12个月时胸廓塌陷恢复最佳,胸廓塌陷指数最小。多因素Logistic回归分析显示:病程<6个月(P=0.048)、BMI<18.5kg/m^(2)(P=0.043)及术前胸膜厚度<1cm(P=0.027)是经隆突平面术后胸廓塌陷显著改善的危险因素;BMI<18.5kg/m^(2)(P=0.042)是经剑突平面术后胸廓塌陷显著改善的独立保护因素。结论通过“胸廓塌陷指数”这一指标定量评价Ⅲ期结核性脓胸的胸廓塌陷程度,初步发现了影响术后胸廓塌陷改善的影响因素。

Objective To find an objective evaluation method for the degree of thoracic collapse of stageⅢtuberculous empyema,and to analyze the related factors affecting the improvement of thoracic collapse after stageⅢtuberculous empyema.Method Retrospective analysis was performed on stageⅢpatients with tuberculous empyema who received surgical treatment in Chengdu Public Health Clinical Center from February 2018 to August 2021.Chest CT examination was performed 12 months after surgery,and the half circumference of the inner margin of the bone of the affected side and the healthy side was measured through the plane of the carina and xiphoid process,and the"thoracic collapse index"was calculated.The study population was divided into the group with significant improvement of thoracic collapse and the group without significant improvement,and the factors affecting the significant improvement of thoracic collapse were analyzed.Result A total of 62 patients were included in the study,including 46 males and 16 females,with an average age of(27.58±12.55)years.The thoracic collapse index in the carina and xiphoid plane after each follow-up period was significantly lower than that before surgery(P<0.05),and the overall trend was gradually decreasing.The thoracic collapse recovery was the best and the thoracic collapse index was the lowest 12 months after surgery.In the follow-up period of 12 months after surgery,the study population was divided into two groups:significantly improved thoracic collapse group and no significantly improved thoracic collapse group according to whether the"improvement percentage of thoracic collapse"was≥4%or not.Multivariate logistic regression analysis showed that the disease course<6 months(P=0.048),BMI<18.5kg/m^(2)(P=0.043)and preoperative pleural thickness<1cm(P=0.027)were the risk factors for significant improvement of thoracic collapse after carinal plane surgery.BMI<18.5kg/m^(2)(P=0.042)was a protective factor that significantly improved thoracic collapse after xiphoid plane surgery.Conclusion In this study,the index"thoracic collapse index"was successfully defined to quantitatively evaluate the degree of thoracic collapse in stageⅢtuberculous empyema,and the related factors affecting the improvement of postoperative thoracic collapse were preliminarily found.