Tuberculosis debridement for the treatment of peripheral localized pulmonary tuberculosis lesions in tuberculous empyema patients

doi:10.3969/j.issn.1000-6621.2018.12.007

Abstract

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

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

Figures/Tables 3

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)

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

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