结核性脓胸胸腔镜辅助纤维板剥脱术手术时机初探

目的:初步探讨结核性脓胸在使用胸腔镜纤维板剥脱术时对于手术时机的选择。方法:根据纳入标准收集符合要求的结核性脓胸患者病例64例,对所有处于不同阶段的病例均进行胸腔镜辅助纤维板剥脱手术,以手术时间、术中出血量、术后放置引流时间及术后引流量作为观察指标,根据观察数据结果的不同分析该种手术治疗的效果,从而得出该种手术方式最适宜的手术时机。结果:与病程≥3个月实行VATS手术患者比较,病程<3个月患者的术中出血量少,术后放置引流管时间及术后引流量少(P<0.05)。与胸膜厚度≥1 cm的患者相比,胸膜厚度<1 cm患者手术时间短,术中出血量少,术后带管时间段,术后引流量少(P<0.05)。肺内有结节患者术中出血量、术后引流量多,术后放置引流管时间长于肺内无结节患者(P<0.05)。结论:对于结核性脓胸患者,病程在<3个月,胸膜厚度<1 cm,肺内无结节时进行VATS纤维板剥脱术可以取得较好的疗效。

持续负压封闭引流-冲洗技术辅助病灶清除术治疗胸壁结核的临床应用

目的 探讨持续负压封闭引流冲洗技术在辅助胸壁结核病灶清除术中应用的疗效.方法 回顾性分析2011年3月至2014年3月在深圳市第三人民医院收治的34例溃破型或术后切口感染的胸壁结核患者的临床资料,所有患者行结核病灶清除术,术后持续冲洗负压封闭引流,观察患者的疗效及预后.结果 34例胸壁结核患者,均使用负压封闭引流治疗7～10 d,其中1例2次更换负压封闭引流海绵,5例1次更换负压封闭引流海绵至病情痊愈,28例未再次更换引流海绵.术后32例患者伤口一期愈合,2例伤口部分感染,经换药后治愈,平均随访1年（3～24个月）,无结核病灶复发.结论 持续负压封闭引流冲洗技术辅助胸壁结核病灶清除术治疗溃破型胸壁结核,临床疗效满意,是治疗胸壁感染的理想方法之一.

ONE CASE REPORT OF ANGINA TONSILLARIS INDUCED MEDIASTINAL ABSCESS AND THORACIC EMPYEMA

A 27-year-old female patient with mediastinal abscess and thoracic empyema developed from angina tonsillaris was studied clinically on the manifestations, computed tomography (CT) scan, and the treatment process. The patient was admitted to hospital with a history of fever, sore throat, and chest and neck pain. CT showed air and air-fluid levels within mediastinal dense fatty planes that extended from the thoracic inlet to the sub-carinal region and left pleural empyema. She was cured by mediastinal drainage and extensive debridement of the necrotic tissue under operation and broad spectrum antibiotics treatment. Angina tonsillaris induced acute mediastitis and mediastinal abscess is a relatively rare inflammatory pathology but actually a fatal situation for its high mortality rate. CT scanning is extremely useful for early diagnosis and surgical treatment planning. The main treatment is aggressive and adequate surgical drainage of the abscess and intravenous effective antibiotic treatment.