论文部分内容阅读
目的 讨改良胸膜纤维板剥脱手术对老年结核性脓胸患者的治疗效果. 方法 集2014年3月至2015年6月在陕西省结核病防治院外科接受治疗,年龄≥65岁的85例结核性脓胸患者的临床资料,根据治疗方法分为传统手术组(40例)和改良手术组(45例),其中传统手术组采用常规手术方式进行治疗,改良手术组在常规手术方式的基础上于术中游离肺叶裂,扩大肺裂间隙.观察两组患者的手术情况,比较两组患者的治疗效果、炎症细胞因子[白细胞介素-12(IL-12)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)]变化情况、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)和第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)]恢复情况和并发症发生情况. 结果 良手术组的手术时间[(109.76±9.14) min]长于传统手术组[(82.93±8.04) min],住院时间[(14.42±2.42) d]短于传统手术组[(18.37±3.12) d],术中出血量[(235.85±18.22) ml]多于传统手术组[(172.46±15.37) ml],差异均有统计学意义(t值分别为-14.29、6.46、-17.22,P值均<0.01);改良手术组治疗6个月有效率(97.78%,44/45)明显高于传统手术组(82.50%,33/40),差异有统计学意义(χ2=5.80,P=0.016);治疗后,改良手术组患者的IL-12[(8.68±0.43) pg/ml]、TNF-α[(8.22±2.06) pg/ml]和CRP[(22.26±8.45) mg/L]水平均明显低于传统手术组患者[分别为(11.92±0.54) pg/ml、(14.25±2.25) pg/ml和(28.17±11.63) mg/L],差异均有统计学意义(t值分别为30.75、12.90、2.70,P值均<0.01);改良手术组患者的FVC[(2.32±0.65) L]、FEV1[(2.13±0.52) L]和FEV1/FVC[(48.26±8.26)%]水平均明显高于传统手术组[分别为(1.83±0.48) L、(1.68±0.34) L和(43.45±6.85)%](t值分别为-3.91、-4.66、-2.90,P值均<0.01);两组患者并发症(包括术后感染、结核播散和复发)发生率[分别为17.50%(7/40)、6.67%(3/45)]差异无统计学意义(χ2=2.39,P=0.122).结论 良胸膜纤维板剥脱术对老年结核性脓胸患者有较好的治疗效果,可明显改善患者的肺功能,具有临床应用价值.“,”Objective To explore the clinical effect of modified decortication of pleural fibreboard on elderly patients with tuberculous empyema.Methods The clinical data of patients with tuberculous empyema who aged ≥65 years and treated in the Department of Surgery, Shaanxi Provincial Tuberculosis Control Hospital from March 2014 to June 2015 were collected.According to the treatment method, patients were divided into traditional surgery group (40 cases) and modified operation group (45 cases).Traditional operation group was operated by routine method;while in the modified operation group, pulmonary lobes were freed and the gap was enlarged.The treatment effect, the levels of cytokines (IL-12, TNF-α and CRP), lung function (FVC, FEV1, and FEV1/FVC) and complication rate were compared between the two groups.Results The operation time of the modified group ((109.76±9.14) min) was longer than the traditional surgery group ((82.93±8.04) min), the hospitalization time ((14.42±2.42) d) was shorter than traditional surgery group ((18.37±3.12) d), and the level of peroperative bleeding ((235.85±18.22) ml) was higher than traditional surgery group ((172.46±15.37) ml);the differences were statistically significant (t=-14.29, 6.46,-17.22, respectively, all P<0.01).The treatment efficiency (97.78%, 44/45) of the modified group was significantly higher than that of the traditional surgery group (82.50%, 33/40);the difference was statistically significant (χ2=5.80, P=0.016).Six months after surgery, patients in the modified group had lower levels of IL-12 ((8.68±0.43) pg/ml), TNF-α ((8.22±2.06) pg/ml) and CRP ((22.26±8.45) mg/L) compared with the traditional surgery group (IL-12, (11.92±0.54) pg/ml;TNF-α, (14.25±2.25) pg/ml;CRP, (28.17±11.63) mg/L;t=30.75, 12.90, 2.70, respectively, all P<0.01).In the modified group, FVC ((2.32±0.65) L), FEV1 ((2.13±0.52) L) and FEV1/FVC ((48.26±8.26) %) were higher than the traditional surgery group (FVC, (1.83±0.48) L;FEV1, (1.68±0.34) L;FEV1/FVC, (43.45±6.85) %;t=-3.91, -4.66, -2.90, all P<0.01).There was no significant difference in the incidence of complications (including postoperative infection, tuberculosis spread and recurrence) between the two groups (17.50% (7/40) versus 6.67% (3/45);χ2=2.39, P=0.122).Conclusion Modified decortication of pleural fibreboard has good therapeutic effect or elderly patients with tuberculous empyema.It can obviously improves the pulmonary function of the patients, with the value of clinical application.