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目的讨论复杂性肺炎旁胸腔积液(complicated parapneumonic effusions,CPE)的最佳治疗方法。方法 21例临床诊断为CPE的患者随机分为胸腔闭式引流结合胸腔内注射链激酶组(CT-SKs,n=10)和内科胸腔镜治疗组(MTs,n=11)。比较2组疗效、住院天数、胸腔引流天数、住院费用以及一次治疗成功率等。结果与CT-SKs相比,MTs初次治疗成功率显著增高[10/11(91%)vs4/10(40%),P<0.05],带管引流时间缩短[(5.8±1.1)dvs(9.8±1.3)d,P<0.05),住院时间缩短[(8.7±0.9)dvs(12.8±1.1)d,P<0.05),住院费用降低[(11045±3411)元vs(18475±5164)元,P<0.05]。所有CT-SKs治疗失败的病例可以使用内科胸腔镜继续治疗而不需要外科手术治疗。结论与常规胸腔引流法相比,内科胸腔镜治疗CPE能缩短住院时间、节省住院费用、获得更好的疗效,值得进一步临床实践推广。
Objective To discuss the best treatment of complicated parapneumonic effusions (CPE). Methods Twenty-one patients with clinically diagnosed CPE were randomly divided into thoracic closed drainage and intrathoracic injection of streptokinase (CT-SKs, n = 10) and medical thoracoscopic treatment group (MTs, n = 11). The efficacy of two groups were compared, the days of hospitalization, the days of pleural drainage, the cost of hospitalization, the success rate of primary treatment and so on. Results Compared with CT-SKs, the success rate of first treatment of MTs was significantly increased [10/11 (91%) vs 4/10 (40%), P <0.05] (P <0.05), shorter hospital stay [(8.7 ± 0.9) d vs (12.8 ± 1.1) d, P <0.05), lower hospitalization costs (11045 ± 3411 vs $ 18475 ± 5164, P <0.05]. All cases of failed CT-SKs can be treated with medical thoracoscopy without the need for surgical intervention. Conclusion Compared with conventional chest drainage, medical thoracoscopic treatment of CPE can shorten the hospitalization time, save hospitalization costs, and obtain better curative effect, which deserves further clinical practice.