胸腔镜胸膜固定术与胸腔闭式引流术治疗大量恶性胸腔积液疗效比较

摘要

目的：比较胸腔镜胸膜固定术与胸腔闭式引流术治疗大量恶性胸腔积液的疗效。方法将2012年1~12月108例大量恶性胸腔积液患者，采用数表法随机分为胸腔镜组与闭式引流组各54例，胸腔镜组行胸腔镜胸膜固定术治疗，胸腔闭式引流组行胸腔闭式引流术治疗，定期复查胸部CT及胸片，治疗前后检测胸腔积液蛋白定量、白细胞计数及乳酸脱氢酶水平数值等，比较两组胸水控制情况、术后引流管留置时间、住院时间及并发症，患者均随访3年，记录复发情况及1年、2年、3年生存率。结果胸腔镜组患者的总有效率为96.30%(52/54)，明显高于闭式引流组的74.07%(40/54)，组间比较差异有显著统计学意义(P<0.01)；两组术后胸液蛋白定量、白细胞计数及乳酸脱氢酶水平均较术前明显降低，胸腔镜组降低幅度明显大于闭式引流组，差异均有显著统计学意义(P<0.01)；胸腔镜组患者引流管留置时间、住院时间均短于闭式引流组，并发症发生率低于闭式引流组，差异均有统计学意义(P<0.01)；随访3年，胸腔镜组远期并发症发生率为3.70%，1年、2年、3年生存率分别为55.56%、33.33%和22.22%，闭式引流组远期并发症发生率为22.22%，1年、2年、3年生存率分别为48.15%，、11.11%和7.41%，差异均有统计学意义(P<0.05或0.01)。结论胸腔镜胸膜固定术治疗大量恶性胸腔积液的有效性及安全性均优于胸腔闭式引流术，值得临床上进一步推广应用。%Objective To observe and compare the efficacy of thoracoscopic pleurodesis with closed thoracic drainage in patients with massive malignant pleural effusion (MPE). Methods From January 2012 to December 2012, 108 cases of patients with massive MPE were randomly divided into the thoracoscope group (thoracoscope thoracoscopy pleural fixation treatment) and the closed drainage group (chest line closed drainage of pleural closed drainage treat-ment) according to digital table, with 54 cases in each group. The chest CT and chest X-ray, quantitative detection of pleural effusion protein before and after the treatment, WBC count and lactate dehydrogenase level were performed period-ically. The chest water control condition, postoperative drainage tube indwelling time, length of hospital stay and complica-tions in the two groups were compared. All patients were followed up for 3 years, and the percentages of patients surviving after years 1 through 3 were recorded. Results The total effective rate of the thoracoscope group (96.30%, 52/54) was significantly higher than that of closed drainage group (74.07%, 40/54), P<0.01. The thoracic fluid protein quantitative, white blood cell count and lactate dehydrogenase levels after treatment in two groups were significantly lower than be-fore treatment (P<0.01). The decrease of those in thoracoscope group was significantly lower than in closed drainage group (P<0.01). The drainage tube indwelling time and hospitalization time in thoracoscope group were significantly shorter than those in closed drainage group (P<0.05). The incidence of complications of thoracoscope group was signifi-cantly lower than that of closed drainage group (P<0.05). After 3 years of follow-up, the long-term complication rate of thoracoscope group (3.70%) was significantly lower than that of closed drainage group (22.22%) (P<0.01). The survival rate after years 1 through 3 were 55.56%, 33.33%and 22.22%for thoracoscope group and 48.15%, 11.11%and 7.41%for closed drainage group. There were significant differences between the two groups in the survival rate after years 1 through 3 (P<0.05 or P<0.01). Conclusion The efficacy and safety of thoracoscopic pleurodesis in treatment of mas-sive MPE are better than closed thoracic drainage. Therefore, it is worth popularizing in clinical application.