Effect of fiberboard stripping by uniportal video-assisted thoracic surgery in the treatment of tuberculous empyema

doi:10.19982/j.issn.1000-6621.20210701

Abstract

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

CLC Number:

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

Figures/Tables 4

References 16

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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)	U值	P值
手术时间[min,M(Q₁,Q₃))]	270.0(210.0,330.0)	210.0(165.0,240.0)	1134.725	<0.01
术中出血量[ml,M(Q₁,Q₃)]	350.0(200.0,600.0)	400.0(300.0,800.0)	1774.672	0.086
术后48h引流量[ml,M(Q₁,Q₃)]	865.0(695.0,1040.0)	585.0(450.0,813.0)	995.463	<0.01
术后住院时间[d,M(Q₁,Q₃)]	14.0(11.0,16.0)	9.0(8.0,11.0)	635.841	<0.01
术后带管时间[d,M(Q₁,Q₃)]	9.0(7.0,14.0)	8.0(7.0,9.3)	1879.735	0.267

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)