胸腔镜手术与引流联合尿激酶治疗纤维脓性期肺炎后脓胸的疗效比较

摘要

目的：观察比较电视辅助胸腔镜手术（VATS）与胸管引流联合尿激酶胸腔注药治疗纤维脓性期肺炎后脓胸的临床效果，以确定此类型脓胸的最佳治疗方案。方法将纤维脓性期脓胸患者按纳入标准和排除标准随机分成2组，VATS组55例，行VATS清理；引流组46例，在B超引导下应用Seldinger法置入12 F导管行胸腔闭式引流，胸腔注入尿激酶10万U，闭管4 h后开放，每天1次，连用3 d。记录各组患者治疗前血白细胞（WBC），胸水pH值、葡萄糖、乳酸脱氢酶（LDH）和C反应蛋白（CRP），治疗后发热持续时间、胸管留置时间、抗生素使用天数、住院天数、治愈率、并发症和住院费用等指标。结果 VATS组治疗后发热持续时间、胸管留置时间、抗生素使用时间、住院天数均短于引流组，治愈率高于引流组（P<0.05）。2组间并发症发生率和住院费用差异无统计学意义。2组均无死亡病例。结论 VATS治疗纤维脓性期肺炎后脓胸的效果优于胸管引流联合尿激酶，未增加并发症和住院费用，值得临床推广。%Objective To compare the clinical effect of video-assisted thoracoscopic surgery (VATS) and chest tube drainage combined with urokinase for the treatment of empyema after fibropurulent pneumonia, and to determine the best therapy for patients. Methods Patients were randomly divided into two groups according to inclusion and exclusion crite⁃ria:55 patients were selected as group VATS performed VATS;46 patients were selected as drainage group performed 12F catheter chest closed drainage by Seldinger technique under B ultrasound guidance. The 100 000 unit urokinase was inject⁃ed into chest, and open after 4-hour closed, once a day for three days. Values of white blood cell (WBC), pH, glucose, lactate dehydrogenase (LDH) and C reactive protein (CRP) of pleural effusion before treatment were recorded, and the duration of fe⁃ver after treatment, duration of chest-tube placement, antibiotic use, hospital stay, cure rate, complication and hospitaliza⁃tion expenses were also recorded. Results The duration of fever after treatment,, duration of chest-tube placement, antibiot⁃ic use and hospital stay were significantly lower in VATS group than those in drainage group. The cure rate was significantly higher in VATS group than that of drainage group (P<0.05). There were no significant differences in complication rates and hospitalization expenses between two groups. There was no death in both two groups. Conclusion VATS is more suitable for the treatment of empyema after fibropurulent pneumonia than chest tube drainage combined with urokinase, and which is worthy of clinical promotion for not adding complication rates and hospitalization expenses.