不同时机行单孔胸腔镜胸膜纤维板剥脱术治疗慢性结核性脓胸的效果及预后分析OACSTPCD
The effect and prognosis analysis of single-port thoracoscopic pleural fibreboard stripping for the treatment of chronic tuberculous empyema at different timing
目的:探讨不同时机行单孔胸腔镜胸膜纤维板剥脱术治疗慢性结核性脓胸的效果与预后.方法:回顾性选取2020 年4 月至2022 年5 月收治的慢性结核性脓胸患者作为研究对象,均行单孔胸腔镜胸膜纤维板剥脱术,按手术时机进行分组,早期组于抗结核治疗6～12 周进行手术治疗,常规组于抗结核治疗12 周后进行手术治疗.比较两组临床疗效、围术期指标、手术前后肺功能指标、生活质量及并发症发生情况.结果:早期组临床总有效率高于常规组,术中出血量、术后 24h引流量少于常规组,胸膜纤维板厚度小于常规组,手术时间、术后带管时间、术后住院时间短于常规组,差异有统计学意义(P<0.05);两组术后拔除胸腔闭式引流管4d时、术后3 个月用力肺活量、第1 秒用力呼气容积、第1 秒用力呼气容积/用力肺活量、最大呼气流速峰值较术前升高,早期组高于常规组(P<0.05);两组术后3 个月躯体健康、心理功能、社会关系、周围环境评分较术前升高,早期组高于常规组(P<0.05);早期组术后并发症发生率低于常规组(P<0.05).结论:早期(抗结核治疗 6～12 周时)行单孔胸腔镜手术治疗慢性结核性脓胸可强化治疗效果,减少术中出血量、术后引流量,缩短手术时间与术后康复进程,改善肺功能,提高生活质量,降低并发症发生率.
Objective:To investigate the effect and prognosis of single-port thoracoscopic pleural fibreboard stripping for the treatment of chronic tuberculous empyema at different timing.Methods:Patients with chronic tuberculous empyema from Apr.2020 to May 2022 were retrospectively selected as the research subjects,all of whom underwent single-port thoracoscopic pleural fibreboard stripping.They were divided into two groups according to different surgical timing,the early group received surgery at 6-12 weeks after anti-tuberculosis treatment,while the conventional group received surgery after 12 weeks of anti-tuberculosis treatment.The clinical effi-cacy,perioperative indicators,and complications of the two groups were compared,as well as the pulmonary function indicators and qua-lity of life before and after surgery.Results:The total clinical effective rate of the early group was91.18%,which was higher than that of the control group(76.47%,P<0.05).The early group had less intraoperative blood loss and postoperative drainage volume at 24 h than the conventional group,and the thickness of pleural fibreboard was fewer than that of the conventional group.The operation time,postoperative tube-carrying time,and postoperative hospitalization time of the early group were shorter than those of the conventional group(P<0.05).The forced vital capacity,forced expiratory volume in one second,forced expiratory volume in one second/forced vital capacity,and peak expiratory flow in both groups increased at 4 d after the removal of chest closed drainage tubes and 3 months after surgery compared with before surgery,and the early group was higher than the conventional group(P<0.05).The scores of physical health,psychological function,social relationship,and surrounding environment in both groups three months after surgery were higher than those before surgery,and the early group was higher than the conventional group(P<0.05).The incidence of postoperative com-plications in the early group was7.35%,which was lower than that in the conventional group(23.53%,P<0.05).Conclusions:Early(at 6 to 12 weeks of anti-tuberculosis treatment)single-port thoracoscopic surgery for chronic tuberculous empyema can enhance the therapeutic effect,reduce intraoperative blood loss and postoperative drainage,shorten the operation time and postoperative recovery process,significantly improve lung function and quality of life,and reduce the incidence of complications.
何超
湖南省胸科医院胸外科,湖南 长沙,410006
临床医学
脓胸,结核性胸膜纤维板剥脱术胸腔镜检查单孔治疗结果预后
Empyema,tuberculousPleural fibreboard strippingThoracoscopySingle-portTreatment outcomePrognosis
《腹腔镜外科杂志》 2024 (11)
810-814,824,6
湖南省卫生健康委科研项目(S2021JJKWLH0344)
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