中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
9期
26-28
,共3页
王东%徐宗祥%张汉江%饶飞
王東%徐宗祥%張漢江%饒飛
왕동%서종상%장한강%요비
脓胸%结核性%改良式胸膜剥脱术%第1秒用力呼气容积
膿胸%結覈性%改良式胸膜剝脫術%第1秒用力呼氣容積
농흉%결핵성%개량식흉막박탈술%제1초용력호기용적
Empyema,tuberculous%Improved decortication%Forced expiratory volume in one second
目的 研究改良式胸膜剥脱术在结核性脓胸治疗中的临床疗效,并对手术的安全性进行分析.方法 选择2007年1月至2010年9月收治的经病理诊断及手术证实为结核性脓胸82例患者,其中改良式胸膜剥脱术44例,全脓胸胸膜剥脱术28例,胸廓成形术10例,回顾性分析总结几种手术治疗方式的手术时间、术中出血量、术后并发症及术后6个月内患者的肺功能恢复情况.结果 术后1年内所有患者均恢复良好,无死亡病例.改良式胸膜剥脱术患者术中出血量(56.23±15.56) ml,显著少于全脓胸胸膜剥脱术患者的(78.65±23.14)ml及胸廓成形术患者的(66.92±19.83)ml,三者比较差异有统计学意义(P＜0.01)；改良式胸膜剥脱术患者无并发症发生,而全脓胸胸膜剥脱术患者术后2例(7.1％,2/28)肺复张不全,胸廓成形术患者术中1例(10.0％,1/10)广泛渗血术野模糊不清,被迫择期手术；改良式胸膜剥脱术患者术后6个月内用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及用力呼气峰流速(PEF)恢复正常的患者分别占95.5％(42/44)、93.2％(41/44)、97.7％(43/44),均优于全脓胸胸膜剥脱术患者的75.0％(21/28)、78.6％(22/28)、85.7％( 24/28)和胸廓成形术患者的80.0％(8/10)、90.0％(9/10)、80.0％(8/10),三者比较差异有统计学意义(P＜0.01)；三者手术时间比较差异无统计学意义(P＞0.05).结论 改良式胸膜剥脱术具有创伤小,出血量少,术后并发症少,术后肺功能恢复快等优势,在治疗结核性脓胸方面具有显著疗效.
目的 研究改良式胸膜剝脫術在結覈性膿胸治療中的臨床療效,併對手術的安全性進行分析.方法 選擇2007年1月至2010年9月收治的經病理診斷及手術證實為結覈性膿胸82例患者,其中改良式胸膜剝脫術44例,全膿胸胸膜剝脫術28例,胸廓成形術10例,迴顧性分析總結幾種手術治療方式的手術時間、術中齣血量、術後併髮癥及術後6箇月內患者的肺功能恢複情況.結果 術後1年內所有患者均恢複良好,無死亡病例.改良式胸膜剝脫術患者術中齣血量(56.23±15.56) ml,顯著少于全膿胸胸膜剝脫術患者的(78.65±23.14)ml及胸廓成形術患者的(66.92±19.83)ml,三者比較差異有統計學意義(P＜0.01)；改良式胸膜剝脫術患者無併髮癥髮生,而全膿胸胸膜剝脫術患者術後2例(7.1％,2/28)肺複張不全,胸廓成形術患者術中1例(10.0％,1/10)廣汎滲血術野模糊不清,被迫擇期手術；改良式胸膜剝脫術患者術後6箇月內用力肺活量(FVC)、第1秒用力呼氣容積(FEV1)及用力呼氣峰流速(PEF)恢複正常的患者分彆佔95.5％(42/44)、93.2％(41/44)、97.7％(43/44),均優于全膿胸胸膜剝脫術患者的75.0％(21/28)、78.6％(22/28)、85.7％( 24/28)和胸廓成形術患者的80.0％(8/10)、90.0％(9/10)、80.0％(8/10),三者比較差異有統計學意義(P＜0.01)；三者手術時間比較差異無統計學意義(P＞0.05).結論 改良式胸膜剝脫術具有創傷小,齣血量少,術後併髮癥少,術後肺功能恢複快等優勢,在治療結覈性膿胸方麵具有顯著療效.
목적 연구개량식흉막박탈술재결핵성농흉치료중적림상료효,병대수술적안전성진행분석.방법 선택2007년1월지2010년9월수치적경병리진단급수술증실위결핵성농흉82례환자,기중개량식흉막박탈술44례,전농흉흉막박탈술28례,흉곽성형술10례,회고성분석총결궤충수술치료방식적수술시간、술중출혈량、술후병발증급술후6개월내환자적폐공능회복정황.결과 술후1년내소유환자균회복량호,무사망병례.개량식흉막박탈술환자술중출혈량(56.23±15.56) ml,현저소우전농흉흉막박탈술환자적(78.65±23.14)ml급흉곽성형술환자적(66.92±19.83)ml,삼자비교차이유통계학의의(P＜0.01)；개량식흉막박탈술환자무병발증발생,이전농흉흉막박탈술환자술후2례(7.1％,2/28)폐복장불전,흉곽성형술환자술중1례(10.0％,1/10)엄범삼혈술야모호불청,피박택기수술；개량식흉막박탈술환자술후6개월내용력폐활량(FVC)、제1초용력호기용적(FEV1)급용력호기봉류속(PEF)회복정상적환자분별점95.5％(42/44)、93.2％(41/44)、97.7％(43/44),균우우전농흉흉막박탈술환자적75.0％(21/28)、78.6％(22/28)、85.7％( 24/28)화흉곽성형술환자적80.0％(8/10)、90.0％(9/10)、80.0％(8/10),삼자비교차이유통계학의의(P＜0.01)；삼자수술시간비교차이무통계학의의(P＞0.05).결론 개량식흉막박탈술구유창상소,출혈량소,술후병발증소,술후폐공능회복쾌등우세,재치료결핵성농흉방면구유현저료효.
Objective To study the clinical effect of improved decortication in treatment of tuberculous empyema as well as the safety of operation.Methods Eighty-two cases who diagnosed as tuberculous empyema by pathology and operation from January 2007 to September 2010 were selected including improved decortication 44 cases,total empyema decortication 28 cases,thoracoplasty 10 cases.The operation time,peri-operative bleeding,postoperative complication and lung function recovery after 6 months operation were followed-up.Results All the patients were in good recovery and there was no death in the operation for 1 year.The peri-operative bleeding in improved decortication was less than that in total empyema decortication and thoracoplasty [(56.23 ± 15.56) ml vs. (78.65 ± 23.14) and (66.92 ± 19.83) ml],and there was significant difference among them(P＜ 0.01 ).There was no postoperative complication in improved decortication,but 2 cases (7.1％,2/28) of partial lung recruitment maneuvers in total empyema decortication,1 case ( 10.0％,1/10) of extensive staxis with selective surgery in thoracoplasty.The proportion of forced vital capacity (FVC),forced expiratory volume in one second (FEV1),peak expiratory flow (PEF) turning to normal after 6 months operation in improved decortication [95.5％(42/44),93.2％(41/44),97.7％(43/44)]were higher than those in total empyema decortication [ 75.0％ (21/28 ),78.6％ (22/28),85.7％ (24/28) ]and thoracoplasty [ 80.0％ (8/10),90.0％ (9/10),80.0％ ( 8/10) ],and there was significant difference among them (P ＜0.01).There was no significant difference in the operation time among them (P ＞0.05).Conclusion Improved decortication has remarkable superiority in curing tuberculous empyema especially it is small in traumatic with less blood loss,fewer postoperative complications,lung function recovery rapidly after operation.
