病灶清除术治疗结核性脓胸并发外周局限性肺结核病灶的效果观察

doi:10.3969/j.issn.1000-6621.2018.12.007

摘要/Abstract

摘要：

目的对比病灶清除术与肺楔形切除术治疗结核性脓胸并发肺结核外周局限性结核病灶的效果,探讨病灶清除术治疗的安全性、有效性。方法回顾性分析2008年1月至2018年1月西安市胸科医院109例结核性脓胸并发外周局限性肺结核患者资料,根据术中处理肺结核病变手术方式不同分为肺结核病灶清除组(29例)和肺楔形切除组(80例)。对比两组患者手术时间、术中出血量、术后肺漏气发生率、术后漏气至漏气消失时间、带管时间、术后残腔发生率、术后住院时间、住院费用。所有患者术后均随访3年。结果病灶清除组术后17例出现肺持续性漏气,楔形切除组术后63例发生肺持续性漏气,发生率分别为58.6%(17/29)和78.8%(63/80),差异有统计学意义(χ ²=4.42,P=0.036)。两组患者术后带管时间分别为(7.2±2.7)d和(8.2±2.3)d,差异有统计学意义(t=-2.01,P=0.046)。两组患者术后住院时间分别为(14.2±2.1)d和(15.1±1.9)d,差异有统计学意义(t=-2.15,P=0.034);住院费用分别为(29016.1±2299.7)元和(41617.2±4244.5)元,差异有统计学意义(t=-15.17,P=0.000)。结论肺结核病灶清除术治疗结核性脓胸并发外周局限性肺结核病变安全、有效,住院费用低于楔形切除术。

关键词: 脓胸, 结核性, 结核, 肺, 胸外科手术, 疗效比较研究

Abstract:

Objective To investigate the safety and efficacy of the debridement for peripheral localized pulmonary tuberculosis lesions in tuberculous empyema patients, via comparing the outcome of debridement and wedge resection procedure.Methods The data of 109 cases who suffered from tuberculous empyema complicated with peripheral localized pulmonary tuberculosis from January 2008 to January 2018 in Xi’an Chest Hospital were analyzed retrospectively. The patients were divided into debridement group (n=29) and wedge resection group (n=80) by different procedures. The operation time, intraoperative bleeding volume, incidence of postoperative pulmonary leak, pulmonary leak time, drainage time, incidence of residual cavity, hospital stay, and hospitalization cost were compared between the two groups. All patients were followed up for 3 years after surgery.Results Persistent pulmonary leak occurred in 17 patients in the debridement group and 63 patients in the wedge resection group. The incidence of postoperative persistent pulmonary leak in the debridement group and pulmonary wedge resection group was 58.6% (17/29) and 78.8% (63/80), respectively, and the difference was statistically significant (χ ²=4.42, P=0.036). The mean drainage time in the two groups was (7.2±2.7) and (8.2±2.3)days, respectively, and the difference was statistically significant (t=-2.01, P=0.046). The mean hospital stay was (14.2±2.1) and (15.1±1.9)days; the difference was statistically significant (t=-2.15, P=0.034). The mean hospitalization cost in the debridement group and pulmonary wedge resection group was (29016.1±2299.7) and (41617.2±4244.5) yuan, respectively; the difference was statistically significant (t=-15.17, P=0.000). Conclusion Tuberculosis debridement is safe and effective for eliminating the localized pulmonary tuberculosis lesions in tuberculous empyema patients and the hospitalization cost is less than pulmonary wedge resection.

Key words: Empyema, tuberculous, Tuberculosis, pulmonary, Thoracic surgical procedures, Compara-tive effectiveness research

韦林,刘玉钢,朱昌生,吴莉,汪林宝,李潜,张会军,鲁增辉,丁超. 病灶清除术治疗结核性脓胸并发外周局限性肺结核病灶的效果观察[J]. 中国防痨杂志, 2018, 40(12): 1275-1279. doi: 10.3969/j.issn.1000-6621.2018.12.007

WEI Lin,LIU Yu-gang,ZHU Chang-sheng,WU Li,WANG Lin-bao,LI Qian,ZHANG Hui-jun,LU Zeng-hui,DING Chao.. Tuberculosis debridement for the treatment of peripheral localized pulmonary tuberculosis lesions in tuberculous empyema patients[J]. Chinese Journal of Antituberculosis, 2018, 40(12): 1275-1279. doi: 10.3969/j.issn.1000-6621.2018.12.007

图/表 3

表1

各类临床特征在两组患者中的分布与分析

临床特征	病灶清除组(29例)	肺楔形切除组(80例)	统计学检验值	P值
性别[例(构成比,%)]			χ²=0.11	0.737
男	17(58.6)	44(55.0)
女	12(41.4)	36(45.0)
年龄(岁, $x ˉ$ ±s)	32.1±10.1	31.0±9.3	t=0.43	0.665
体质量指数( $x ˉ$ ±s)	19.3±2.3	18.6±2.1	t=1.45	0.150
脓胸范围[例(构成比,%)]			χ²=0.17	0.680
局限性脓胸	25(86.2)	73(91.2)
全脓胸	4(13.8)	7(8.8)
肺部病灶数目[例(构成比,%)]			χ²=1.32	0.250
1个	23(79.3)	72(90.0)
2个	6(20.7)	8(10.0)
卫星灶[例(构成比,%)]			χ²=0.02	0.882
有	5(17.2)	12(13.8)
无	24(82.8)	68(86.2)

表1

图1

表2

不同观察项目在两组患者围手术期观察结果的对比分析

观察项目	病灶清除组(29例)	肺楔形切除组(80例)	统计值	P值
手术时间(min, $x ˉ$ ±s)	135.7±19.4	140.2±25.3	t=-0.86	0.391
术中出血量(ml, $x ˉ$ ±s)	465.2±118.2	457.0±132.7	t=0.29	0.771
术后肺漏气[例(发生率,%)]	17(58.6)	63(78.8)	χ²=4.42	0.036
术后肺漏气至漏气消失时间(d, $x ˉ$ ±s)	3.9±1.9	3.4±1.7	t=1.01	0.315
术后带管时间(d, $x ˉ$ ±s)	7.2±2.7	8.2±2.3	t=-2.01	0.046
术后胸腔内残腔[例(发生率,%)]	1(3.4)	10(12.5)	χ²=1.05	0.305
术后住院时间(d, $x ˉ$ ±s)	14.2±2.1	15.1±1.9	t=-2.15	0.034
术后抗结核药物治疗时间(月, $x ˉ$ ±s)	11.1±1.8	11.2±2.4	t=-0.22	0.826
住院费用(元, $x ˉ$ ±s)	29016.1±2299.7	41617.2±4244.5	t=-15.17	0.000

表2

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