单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效观察

doi:10.19982/j.issn.1000-6621.20210701

摘要/Abstract

摘要：

目的: 探讨单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效。方法: 收集武汉市肺科医院行纤维板剥脱术的132例患者的临床资料,根据手术方式分为传统开胸组(2017年6月至2018年8月期间入院的74例患者)和单孔胸腔镜组(2020年5月至2021年6月期间入院的58例患者),对两组患者的手术时间、术中出血量、术后48h引流量、术后住院时间、带管时间、并发症(再次手术止血率、切口感染率、术侧胸壁感觉异常发生率)和治疗效果等进行统计分析。结果: 单孔胸腔镜组的手术时间[210.0(165.0,240.0)min]、术后48h引流量[585(450,813)ml]和术后住院时间[9.0(8.0,11.0)d]均低于传统开胸组[分别为270.0(210.0,330.0)min、865(695,1040)ml和14.0(11.0,16.0)d],差异均有统计学意义(U值分别为1134.725、995.463、635.841,P值均<0.01)。单孔胸腔镜组术中出血量[400(300,800)ml]、术后带管时间[8.0(7.0,9.3)d]、再次手术止血率[0.0%(0/58)]和切口感染率[1.7%(1/58)]与传统开胸组[分别为350(200,600)ml、9.0(7.0,14.0)d、1.4%(1/74)、4.1%(3/74)]比较差异均无统计学意义(U=1774.672、U=1879.735、χ²=1.163、χ²=0.637,P值分别为0.086、0.267、0.281、0.425);而术侧胸壁感觉异常发生率传统开胸组为95.9%(71/74),显著高于单孔胸腔镜组的15.5%(9/58),差异有统计学意义(χ²=101.834,P<0.01)。随访5个月以上,传统开胸组总有效率为93.2%(69/74),单孔腔镜组的总有效率为94.8%(55/58),差异无统计学意义(χ²=0.149,P=0.928)。结论: 与传统开胸相比,单孔胸腔镜行纤维板剥脱术治疗Ⅲ期结核性脓胸安全有效,且创伤更小,值得临床推广。

关键词: 脓胸,结核性, 胸腔镜检查, 对比研究

Abstract:

Objective: To explore the effect of uniportal video-assisted thoracic surgery (U-VATS) with fiberboard stripping in the treatment of tuberculous empyema. Methods: Clinical data of 132 cases underwent fiber stripping in Wuhan Pulmonary Hospital were collected. According to the operation style, they were divided into open thoracotomy group (n=74, hospitalized from June 2017 to August 2018) and U-VATS group (n=58, hospitalized from May 2020 to June 2021). The duration of operation, intraoperative hemorrhage, drainage 48 h postoperative, postoperative hospital stay, tube time complications (including reoperation hemostasis rate, incision infection rate, the incidence of paresthesia on the surgical side of the chest wall) and effects of the two groups were analyzed. Results: The duration of operation time, 48 h drainage volume and postoperative hospital stay in U-VATS group were significantly lower than those in the open thoracotomy group (210.0 (165.0, 240.0) min vs. 270.0 (210.0,330.0) min, U=1134.725; 585 (450, 813) ml vs. 865 (695, 1040) ml, U=995.463; 9.0 (8.0, 11.0) d vs. 14.0 (11.0, 16.0) d,(U=635.841; all P<0.01). The intraoperative hemorrhage, postoperative tube time, total efficiency, reoperation hemostasis rate and incision infection rate in U-VATS group was no statisticall different from those in the open thoracotomy group (400 (300,800) ml vs. 350 (200, 600) ml, U=1774.672, P=0.086; 8.0 (7.0, 9.3) d vs. 9.0 (7.0, 14.0) d, U=1879.735, P=0.267; 0.0% (0/58) vs. 1.4% (1/74), χ²=1.163, P=0.281; 1.7% (1/58) vs. 4.1% (3/74),χ ²=0.637, P=0.425,respectively). The incidence of paresthesia on the surgical side of the chest wall was 95.9% (71/74) in the open thoracotomy group, which was significantly higher than that in the Uniportal Video-Assisted Thoracic Surgery group (15.5% (9/58), χ ²=101.834, P<0.01).After over 5 months follow-up, the total effective rate in the open thoracotomy group was 93.2% (69/74), which was not statistically different from that in the Uniportal Video-Assisted Thoracic Surgery group (94.8% (55/58),χ ²=0.149, P=0.928). Conclusion: Compared with open thoracotomy, U-VATS for the treatment of stage Ⅲ tuberculous empyema was safe and effective, with less trauma, and was worthy of clinical promotion.

Key words: Empyema,tuberculosis, Thoracoscopy, Comparative study

中图分类号:

刘小玉, 徐风, 周逸鸣, 戴希勇, 盛健, 蒋钰辉, 刘奇斌, 申磊. 单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效观察[J]. 中国防痨杂志, 2022, 44(2): 153-158. doi: 10.19982/j.issn.1000-6621.20210701

LIU Xiao-yu, XU Feng, ZHOU Yi-ming, DAI Xi-yong, SHENG Jian, JIANG Yu-hui, LIU Qi-bin, SHEN Lei. Effect of fiberboard stripping by uniportal video-assisted thoracic surgery in the treatment of tuberculous empyema[J]. Chinese Journal of Antituberculosis, 2022, 44(2): 153-158. doi: 10.19982/j.issn.1000-6621.20210701

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一般情况	传统开胸组(74例)	单孔腔镜组(58例)	统计检验值	P值
性别[例数,构成比(%)]			χ²=0.011	0.917
男性	63(85.1)	49(84.5)
女性	11(14.9)	9(15.5)
合并肺结核[例,构成比(%)]			χ²=0.513	0.474
是	54(73.0)	39(67.2)
否	20(27.0)	19(32.8)
低密度线[例,构成比(%)]			χ²=2.559	0.110
有	41(55.4)	24(41.4)
无	33(44.6)	34(58.6)
肋间隙狭窄[例,构成比(%)]			χ²=0.968	0.325
有	59(79.7)	41(70.7)
无	15(20.3)	17(29.3)
手术部位[例,构成比(%)]			χ²=2.702	0.100
左	34(45.9)	35(60.3)
右	40(54.1)	23(39.7)
年龄[岁,M(Q₁,Q₃)]	30(23,45)	26(21,45)	U=1888.528	0.237
病程[月,M(Q₁,Q₃)]	4.0(2.0,7.0)	6.0(3.0,12.0)	U=1760.742	0.075
抗结核时长[月,M(Q₁,Q₃)]	4.0(1.0,6.25)	3.0(2.0,6.0)	U=2122.198	0.913
血红细胞沉降率[mm/1h,M(Q₁,Q₃)]	31.0(8.5,58.0)	32.0(17.0,2.5)	U=1369.394	0.141
血白蛋白(g/L,$\overline{x}±s$)	38.83±3.89	39.45±3.90	t=0.910	0.365

相关指标	传统开胸组(74例)	单孔腔镜组(58例)	χ²值	P值
治疗效果[例,构成比(%)]			0.149	0.928
治愈	58(78.4)	46(79.3)
好转	11(14.8)	9(15.5)
未愈	5(6.8)	3(5.2)
手术止血[例,构成比(%)]			1.163	0.281
有	1(1.4)	0(0.0)
无	73(98.6)	58(100.0)
切口感染[例,构成比(%)]			0.637	0.425
有	3(4.1)	1(1.7)
无	71(95.9)	57(98.3)
胸壁感觉异常[例,构成比(%)]			101.834	<0.01
有	71(95.9)	9(15.5)
无	3(4.1)	49(84.5)