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目的观察内科胸腔镜治疗结核性包裹性胸腔积液的疗效。方法结核性包裹性胸腔积液病人126例,随机分为治疗组(胸腔镜组)及对照组(尿激酶组),每组各63例,胸腔镜组采用胸腔镜介入下治疗,对照组于胸腔内注入尿激酶10万U。比较两组胸腔积液胸腔粘连、引流量及胸膜厚度,治疗后肺功能以及住院费用。结果治疗组胸水纤维分隔粘连多房形成发生率7.9%,而对照组为34.9%(P<0.05);胸腔镜组胸腔积液引流量平均为(2500±450)ml,显著多于对照组的(1500±320)ml(P<0.01);治疗组胸膜厚度为(1.15±0.32)mm,显著低于对照组(1.97±0.45)mm(P<0.01);肺功能治疗组FEV1(%)为89.8±1.8,对照组82.2±2.2;治疗组FVC(%)96.1±2.3,对照组88.3±2.5(P<0.01);住院天数治疗组8.0±3,对照组7.5±2(P>0.05);住院费用治疗组2700±500,对照组2500±450。结论内科胸腔镜治疗包裹性胸腔积液,可以显著减少胸腔分隔,粘连,多房形成,减轻胸膜肥厚,以及改善肺功能,而住院天数费用较传统方法无明显增加。
Objective To observe the effect of medical thoracoscopic treatment of tuberculous pleural effusion. Methods 126 patients with tuberculous pleural effusion were randomly divided into treatment group (thoracoscope group) and control group (urokinase group), 63 cases in each group. The thoracoscope group was treated by thoracoscope intervention, while the control group Thoracic injection of urokinase 100,000 U. Thoracentesic pleural adhesions, drainage and pleural thickening, post-treatment lung function and hospitalization costs were compared between the two groups. Results The incidence of pleural effusion in the treatment group was 7.9%, compared with 34.9% in the control group (P <0.05). The average pleural effusion volume in the thoracoscopic group was (2500 ± 450) ml, significantly higher than that in the control group (1500 ± 320) ml (P <0.01). The thickness of the pleura in the treatment group was (1.15 ± 0.32) mm, which was significantly lower than that in the control group (1.97 ± 0.45) mm 89.8 ± 1.8 in the control group and 82.2 ± 2.2 in the control group. The FVC (%) was 96.1 ± 2.3 in the treatment group and 88.3 ± 2.5 in the control group (P <0.01). The hospitalization days were 8.0 ± 3 in the treatment group and 7.5 ± 2 in the control group (P> 0.05) Inpatient cost treatment group 2700 ± 500, control group 2500 ± 450. Conclusion The medical thoracoscopic treatment of paroxysmal pleural effusion can significantly reduce the pleural separation, adhesions, multiple room formation, reduce pleural hypertrophy, and improve lung function, and the cost of hospital days than the traditional method was not significantly increased.