结核性包裹性胸腔积液不同时机手术疗效比较

摘要

目的：比较结核性包裹性胸腔积液患者不同时机行胸膜纤维板剥脱术的疗效,探讨手术治疗的最佳时机。方法将诊断明确的240例初治结核性包裹性胸腔积液患者分为4组,其中只进行内科保守治疗的患者60例( A组)；保守治疗1个月后手术的60例( B组),保守治疗2个月后手术的60例( C组)；直接手术的60例(D组)。结果 D组的总有效率高于A组,组间差异具有统计学意义(χ2=6．325,P=0．012)；C组总有效率高于B组,组间差异具有统计学意义(χ2=5．045,P=0．034)；A组与D组治疗后的各项指标间的比较差异具有统计学意义( P<0．05)；B组与C组在FVC、FEV1方面的组间比较差异具有统计学意义( P<0．05)；C组与D组在胸膜厚度、FVC方面的组间比较差异具有统计学意义(P<0．05)；A组不良反应发生率显著高于D组,两组间比较差异具有统计学意义(χ2=13．264,P=0．000)。结论初治结核性包裹性胸腔积液患者在抗结核及胸腔穿刺抽液2个月后疗效改善不明显时,可行手术治疗。%Objective To compare the curative effect of patients with tuberculous encapsulated pleural effu-sion and to investigate the timing of surgical treatment. Methods 240 initial treatment tuberculosis encapsulated pleural effusion patients were divided into 4 groups, 60 cases in every group. The group A was given conservative treatment, the group B was given 1-month conservative treatment then accepted surgery, the group C was given 2-month conservative treatment then accepted surgery, and the group D was given direct operation. Results The total efficiency was obviously better in the group D than in the group A (χ2 =6. 325, P=0. 012), and the group C was better than the group B (χ2 =5. 045, P=0. 034). The difference of the indexes after treatment between the group A and the group D had statistical significance (P<0. 05). The difference in FVC and FEV1 between the group B and the group C had statistical significance (P<0. 05). There were significant differences in pleural thickness and FVC between the group C and the group D (P<0. 05). The incidence of adverse reactions was significantly higher in the group A than in the group D (χ2 =13. 264, P=0. 000). Conclusion If there is no significant improvement of effi-cacy in drug and thoracic puncture and drainage treatment after 2 months, operation could be an effective treatment for initial treatment tuberculous encapsulated pleural effusion.