电视胸腔镜脓胸廓清术治疗结核性脓胸

目的探讨电视胸腔镜脓胸廓清术治疗结核性脓胸的疗效。方法 2004年1月～2011年6月对82例早期结核性脓胸(病史2周～2个月,处于渗出期和纤维机化早期)行电视胸腔镜脓胸廓清术,在胸腔镜下分离粘连,清理脓苔,刮除脏、壁层胸膜上干酪样物、坏死和肉芽组织,剥除增厚的纤维板,术中反复冲洗,术后充分引流、注药,同时全身抗结核治疗。结果 82例电视胸腔镜脓胸廓清术均顺利完成,术后5～7 d顺利拔管。术后1个月复查CT示脓腔消失,肺脏膨胀良好;术后1个月痰查结核菌无阴转阳者,术前阳性2例分别于术后1、3个月转阴。术后1个月用力肺活量、第1秒用力肺活量、肺总量与术前相比明显改善(P<0.05)。结论电视胸腔镜脓胸廓清术治疗纤维素期和纤维机化早期的结核性脓胸是安全、有效的方法。

Video-assisted Thoracoscopic Surgery for Tuberculous Empyema

Objective To evaluate the efficacy of video-assisted thoracoscopic surgery(VATS) for thoracic tuberculous empyema.Methods From January 2004 to June 2011,we performed VATS on 82 patients with early tuberculous empyema(course of disease: 2 weeks to 2 months,in exudative or early fibrosis stage).Under a thoracoscope,we separated adhesions,cleaned up the pus moss,scraped fabric,caseous necrosis and granulation tissues on the parietal and visceral pleurae,and stripped the thickened fiberboard;meanwhile,the surgical field was washed repeatedly.After the procedure,sufficient drainage,injection and anti-tuberculosis therapy were carried out.Results Thoracic empyema clearance was successfully completed in all the 82 patients,who were extubated smoothly in 5-7 days.One months after the surgery,CT examination showed disappearance of abscess cavity and fine lung expansion.Two patients,who had positive sputum for tubercle bacilli,converted to negative in 1 and 3 months respectively,and no cases converted from negative to positive.FVC,FEV1,and TLC of the patients were improved in one month compared to preoperation(P<0.05).Conclusion VATS is safe and effective for cellulose fiber and early fibrosis stage tuberculous empyema.