不同手术方案治疗化脓性包裹性胸腔积液的疗效及安全性
A Study of Efficacy and Safety of Different Surgical Procedures in the Treatment of Suppurative Encapsulated Pleural Effusion
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摘要: 目的 分析不同手术方案治疗化脓性包裹性胸腔积液临疗效及安全性, 为临床化脓性包裹性胸腔积液患者治疗方案选择提供参考.方法 选择2011年2月至2017年2月攀枝花市第二人民医院收治的化脓性包裹性胸腔积液患者68例作为研究对象, 按照就诊顺序编号, 采用数字随机表法将其分为A组和B组, 每组34例.A组患者采用胸腔镜小切口胸腔廓清及纤维板剥脱术治疗, 术中采用抗菌药物冲洗胸腔, B组患者在A组手术基础上, 置入带侧孔静脉导管, 术后每日加用抗菌药物冲洗胸腔, 连续使用3 d.比较2组患者术后1月的临床疗效、并发症发生情况及静脉导管拔除时间情况.比较2组患者术后3 d静脉导管液中白细胞计数 (WBC) 、谷氨酸 (Glu) 、乳酸脱氢酶 (LDH) 水平, 比较2组患者术前及拔除静脉到观后的呼吸功能能指标 (FVC、FEV1) 、胸膜厚度改善情况, 术后随访1 a, 比较两组患者复发率.分析2种手术方案治疗化脓性包裹性胸腔积液患者的疗效及安全性的优劣.结果 术后1月, A组患者临床总有效率明显低于B组患者 (P<0.05) .静脉导管拔除时间明显长于B组 (P<0.05) , A组患者术后1月并发症3例, B组患者并发症4例, A组患者并发症率低于B组患者, 但组间比较差异无统计学意义 (P>0.05) .术后3 d, A组患者WBC、Glu明显高于B组患者, LDH明显低于B组患者 (P<0.05) .A组患者拔除静脉导管后FVC、FEV1均明显低于B组患者, 胸膜厚度高于A组患者 (P<0.05) .术后随访1 a, A组患者中治愈出院的27例患者中4例出现复发, 复发率14.81%, B组中治愈出院的31例患者中仅2例复发, 复发率6.45%, A组复发率明显高于B组 (χ2=4.593, P<0.05) .结论 胸腔镜小切口胸腔廓清及纤维板剥脱术联合术后抗菌药物冲洗胸腔, 可提升患者临床疗效, 但同时增加了患者经济负担, 临床应个性化选择使用.Abstract: Objective To analyze the efficacy and safety of different surgical procedures in the treatment of suppurative encapsulated pleural effusion. Me thods Sixty-eight patients with suppurative pleural effusion were randomly divided into group A and group B, with 34 cases in each group. The two groups of patients were treated with thoracoscopic small incision thoracoscopic clearance and fibreboard exfoliation. In group A, antibiotics were used to rinse the chest. Group B was placed with lateral venous catheter during operation. Then we used antibacterial agents to irrigate the thoracic cavity. The clinical efficacy, complications, removal time of venous catheters, white blood cell count (WBC) , glutamic acid (Glu) , lactate dehydrogenase (LDH) level, and respiratory function index (FVC, FEV1) in intravenous catheter fluid, pleural thickness, and recurrence rate after oneyear were compared between the two groups.Results The clinical total effective rate of group A was significantly lower than that in group B. Intravenous catheter removal time was significantly longer than that in group B. WBC and Glu after 3 d were significantly higher than those of group B. LDH was significantly lower than that of group B. FVC and FEV1 after the extraction of venous catheter were significantly lower than those in group B. Pleural thickness was higher in group B. The rate of recurrence after one year was higher than that in group B. Conclusion Thoracoscopic small incision thoracic dissection and fibrinectomy and postoperative antibiotics flushing the thoracic cavity can improve the clinical efficacy, but at the same time it increases the economic burden on the patient and should be personalized for clinical use.
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