尿激酶胸腔内注射治疗结核性包裹性胸腔积液42例疗效观察

目的:观察尿激酶治疗包裹性胸腔积液的效果.方法:对42例患者随机分成两组,观察组,对照组各21例,治疗组在抗痨治疗的基础上,胸腔注射尿激酶10万单位+生理盐水20ml,对照组用氟美松5mg+生理盐水20ml;结果:治疗治疗组显效18例(85.7％),有效(14.0％)有效率100％,对照组显效4(19.0％),有效12( 57.1％),无效5(23.8％),有效率76.2％,x2=16.2 P＜0.01,两组差异有显著性.结论:尿激酶胸腔注射能减少包裹性积液的形成,减少病人手术治疗机会.     

巴曲酶胸腔内注射治疗包裹性胸腔积液18例

结核性渗出性胸膜炎常由于治疗不当或反复多次胸腔穿刺抽液导致包裹性积液。包裹性，特别是多房性包裹性积液形成后，常规治疗效果不佳，预后不良。我院自1995-2003年对18例结核性胸膜炎导致包裹性胸腔积液的患者，在常规治疗方法的基础上同时加巴曲酶(北京托毕西药业有限公司生产)胸腔内注射治疗，疗效满意。     

胸腔镜辅助治疗早期结核性包裹性胸腔积液112例

目的：探讨胸腔镜辅助治疗结核性包裹性胸腔积液的效果。方法2003年10月～2012年9月,对112例早期结核性包裹性胸膜炎并胸腔积液患者行胸腔镜辅助治疗,将包裹分隔用胸腔镜活检钳及电凝钩分离,清除分隔内的干酪坏死组织、纤维板及胸腔积液,胸腔内放置中心静脉导管,术后用尿激酶溶解纤维素。术后给予抗结核药物治疗。结果111例肺完全复张,1例右下肺未完全膨胀。2例术后其他细菌感染,经抗生素治疗痊愈。112例随访9～12个月,平均9．4月,无复发。结论对内科反复穿刺及置管引流不.的早期结核性包裹性胸腔积液,胸腔镜辅助手术治疗安全有效,无明显并发症。     

电视胸腔镜手术治疗恶性胸腔积液37例临床分析

目的探讨电视胸腔镜手术治疗恶性胸腔积液的方法,总结其临床经验。方法回顾性分析2009年1月至2011年12月宝鸡市中心医院37例恶性胸腔积液患者的临床资料,男21例、女16例,年龄43～75岁。其中肺癌15例,乳腺癌7例,食管癌7例,胃癌4例,胸膜间皮瘤3例,卵巢癌1例;均为单侧胸腔积液,其中左侧胸腔积液22例,右侧胸腔积液15例。所有患者均行电视胸腔镜手术（VATS）或VATS辅助小切口完成手术,在电视胸腔镜下行胸膜剥脱术,并喷洒滑石粉固定胸膜。结果围术期无死亡,7例（18.9%）延长切口,手术时间（40.32±19.06）min,术中出血量（90.09±41.03）ml,术后（7.31±2.08）d拔除胸腔引流管,术后住院时间（9.02±3.11）d。手术有效率100%,其中完全缓解19例（51.4%）。术后出现轻度并发症,如肺部感染、持续性漏气和切口感染等,经对症处理治愈。结论电视胸腔镜治疗恶性胸腔积液是一种微创、有效、实用的治疗方法。     

尿激酶治疗胸膜剥脱术后早期凝固性血胸的疗效分析

目的探讨采用尿激酶胸腔灌注的方法治疗胸膜剥脱术后凝固性血胸的疗效。方法选取2014年3月至2016年12月我院胸外科胸膜剥脱术后并发凝固性血胸的63例患者,均采用尿激酶胸腔灌注方法进行治疗,报告引流液情况及X线检查结果,综合分析其治疗效果。结果所有人注药过程顺利,其中48例治愈,13例有效,2例无效。治愈率84.1%,总有效率96.8%,整个治疗过程中患者均耐受良好,8例伴有轻度胸痛、7例气促、3例出现低热,经对症治疗后缓解,仅1例出现大出血,经药物止血治疗后治愈,无其他严重不良反应。结论尿激酶胸膜腔内灌注治疗早期凝固性血胸简单、安全、创伤小、疗效肯定,不良反应发生率低,无须特殊设备。     

尿激酶治疗胸膜剥脱术后早期凝固性血胸的疗效分析

［摘要］ 目的 探讨采用尿激酶胸腔灌注的方法治疗胸膜剥脱术后凝固性血胸的疗效。方法 选取2014年3月至2016年12月我院胸外科胸膜剥脱术后并发凝固性血胸的63例患者,均采用尿激酶胸腔灌注方法进行治疗,报告引流液情况及X线检查结果,综合分析其治疗效果。结果 所有人注药过程顺利,其中48例治愈,13例有效,2例无效。治愈率84.1%,总有效率96.8%,整个治疗过程中患者均耐受良好,8例伴有轻度胸痛、7例气促、3例出现低热,经对症治疗后缓解,仅1例出现大出血,经药物止血治疗后治愈,无其他严重不良反应。结论 尿激酶胸膜腔内灌注治疗早期凝固性血胸简单、安全、创伤小、疗效肯定,不良反应发生率低,无须特殊设备。     

电视胸腔镜下胸膜纤维板剥脱术治疗脓胸及包裹性胸腔积液

电视胸腔镜下胸膜纤维板剥脱术治疗脓胸及包裹性胸腔积液朱成楚叶加洪叶中瑞郭剑波作者单位：３１７０００浙江省台州医院胸外科我们自１９９５年７月至１９９７年７月，应用胸腔镜作脓胸、包裹性胸腔积液清除术４８例，其中３７例作了胸膜纤维板剥脱术，现报告如下：临床...     

腹腔镜手术治疗盆腔包裹性积液

目的探讨腹腔镜手术治疗盆腔包裹性积液的临床效果。方法2001年5月-2004年12月在我院诊断为盆腔包裹性积液28例（均经盆腔彩超检查确诊），行腹腔镜手术治疗。结果28例手术全部成功，无术中、术后并发症发生，手术时间25～95min，平均41min。术中出血量15～85ml，平均35ml。术后住院3—5d，平均4d。术后下腹坠胀痛、肛门坠胀感症状完全消失，术后随访1年，彩超未见复发。结论腹腔镜手术治疗盆腔包裹性积液是安全可行的，根据患者年龄、是否有生育要求、盆腔粘连程度及盆腔包裹性积液的量进行不同的手术。     

分析胸膜纤维板剥脱术治疗慢性结核性脓胸的效果及安全性

目的分析胸膜纤维板剥脱术治疗慢性结核性脓胸的效果及安全性。方法选取2017-07-2019-07间濮阳市第五人民医院收治的62例慢性结核性脓胸患者,均行胸膜纤维板剥脱术治疗。回顾性分析近期治疗效果。结果本组术中出血量为(650.24±45.16)mL,术后病理学检查结果均为结核性病变。术后脓腔消失,未发生感染、肺不张、出血、肺漏气等并发症,均顺利出院。随访3个月,其间53例(85.48%)病情完全改善,7例(11.29%)病情好转,2例(3.23%)脓胸复发。结论胸膜纤维板剥脱术是治疗慢性结核性脓胸有效和安全的术式。     

腹腔镜手术治疗盆腔包裹性积液99例分析

目的探讨腹腔镜手术治疗盆腔包裹性积液的的可行性和安全性。方法2009年1月~2018年4月我科99例术前盆腔肿物性质不明,术后病理诊断为盆腔包裹性积液。年龄<40岁、有生育需求者行腹腔镜患侧附件囊肿剥除术;绝经期、年龄>45岁且无生育需求者行腹腔镜患侧附件切除术;年龄40~45岁,根据既往手术史、有无生育需求并结合患者个人意愿决定行腹腔镜患侧附件囊肿剥除术或患侧附件切除。结果98例完成腹腔镜手术,1例因粘连严重中转开腹。术中见99例均存在粘连,其中重度粘连(mAFS评分5~6分)76例。行患侧囊肿剥除术69例,患侧附件切除术30例,同时行粘连松解术。手术时间19~285 min,中位数88 min。术中出血量5~200 ml,中位数25 ml。截止2019年3月,随访78例,其中30例随访不足1年,48例随访1~10年(中位随访时间3.5年),6例(12.5%)超声检查示再发盆腔包块(复发时间术后2个月~5年,中位数20个月),其中2例出现下腹痛等症状,其余均为无症状复发。结论腹腔镜手术治疗盆腔包裹性积液安全、可行。     

高频超声引导下胸腔积液置管引流

胸腔积液临床常见,少量积液常无症状,中大量积液可致患者出现呼吸困难、无法平卧等表现,需通过胸腔穿刺置管引流及时加以缓解。胸腔积液穿刺引流不仅可用于临床治疗,还可辅助诊断不明原因胸腔积液。在超声直视下操作置管可提高穿刺成功率[1-2]。本研究观察高频超声在辅助引导置管引流胸腔积液中的效果。     

胸膜厚度联合外周血结核感染T细胞斑点试验鉴别诊断结核性与恶性胸腔积液

目的 评价胸膜厚度联合外周血结核感染T细胞斑点试验（T-SPOT.TB）鉴别结核性与恶性胸腔积液的价值。方法 纳入284例结核性胸膜炎患者（结核组）及213例恶性胸腔积液患者（恶性组）。采用超声测量胸膜厚度,并进行外周血T-SPOT.TB,比较组间结果差异;利用多因素logistic回归分析观察二者是否为恶性胸腔积液的独立危险因素。绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评价胸膜厚度、外周血T-SPOT.TB及二者联合鉴别结核性与恶性胸腔积液的效能,并以DeLong检验比较其效能差异。结果 2组间胸膜厚度及外周血T-SPOT.TB结果差异均存在统计学意义（P均<0.05）,且此二项均为判断胸腔积液性质的独立危险因素,其OR分别为0.67[95%CI（0.60,0.75）,P<0.05]及6.79[95%CI（4.44,10.39）,P<0.05]。以胸膜厚度鉴别结核性与恶性胸腔积液的AUC为0.71,截断值取0.55 mm时,其诊断的敏感度为90.84%,特异度为45.08%;以外周血T-SPOT.TB鉴别诊断的AUC为0.72,敏感度为72.89%,特异度为70.89%;二者联合鉴别诊断的AUC为0.81,高于单一指标（P均<0.01）,敏感度为65.49%,特异度为83.10%。结论 胸膜厚度和外周血T-SPOT.TB可用于鉴别结核性与恶性胸腔积液,且二者联合可提高鉴别特异度。     

Thymoma with spontaneous regression and disappearance of pleural effusion

A 31-year-old woman was admitted to our hospital with sudden onset of chest pain. Chest radiography and computed tomography (CT) on admission showed an anterior mediastinal tumor with left pleural effusion, which was diagnosed as an inoperable malignant mediastinal tumor. However, 3 weeks after admission CT showed that the tumor was diminishing and the pleural effusion had disappeared without any treatment. CT-guided needle biopsy was performed, but diagnosis was impossible because most of the specimen was necrotic. A biopsy during video-assisted thoracic surgery was then performed. The intraoperative finding showed that the tumor was round, well mobilized, and did not invade adjacent structures. It was then assumed to be a benign teratoma that had been ruptured into the thoracic cavity. The operation was converted to a thoracotomy to resect it, but it could not be completely resected because of inflammatory adhesions to the mediastinum. Two months later, total thymectomy was performed through a median sternotomy because the tumor was pathologically diagnosed as a thymoma.     

A pancreatic pseudocyst with pancreatic pleural effusion: Report of a case

A 54-year-old man with a 30-year history of chronic alcoholism was admitted to our hospital suffering from dyspnea and left-sided chest pain. A chest radiograph revealed pleural effusion. Computed tomography revealed a pancreatic pseudocyst in the tail of the pancreas spreading out to the posterior mediastinum and the left pleural cavity. The laboratory findings of pleural effusion were as follows: amylase, 118400 IU/1; protein, 4.6 g/dl; class I in cytology. Despite a reduction in the pleural effusion by conservative therapy, left back pain and a recurrence of the pleural effusion were observed after oral intake was re-initiated. A distal pancreatectomy and ligation of the pancreaticopleural fistula were thus performed on the 75th hospital day. The patient made a complete recovery from pancreatic pleural effusion and has now been well for 9 years.     

The intrapleural administration of recombinant interleukin-2 (rIL-2) to patients with malignant pleural effusion: Clinical trials

Recombinant IL-2 (rIL-2) was administered intra-pleurally according to an original protocol to 11 patients with malignant pleural effusion, 7 of whom suffered from breast cancer and 4 from esophageal cancer. The pleural effusions either disappeared or decreased roentgenographically, and malignant cells disappeared from all 13 pleural cavities in the 11 patients, confirming the validity of this therapy to be 100%. The mean survival time from the initial administration of rIL-2 was 15.9 months. We ensured that the concentration of IL-2 in the effusion was maintained at a high level for a sufficient period of time, and that the lymphokine-activated killer (LAK) activity of lymphocytes in the effusion was augmented. Fever, eosinophilia, and a transient increase in the pleural effusion were the main side effects, but the symptoms were temporary and not serious. The results of this study therefore suggest the efficacy of intrapleural rIL-2 for patients with malignant pleural effusion.     

Characteristic pattern of pleural effusion in electrical impedance tomography images of critically ill patients

Background

Electrical impedance tomography (EIT) is increasingly used for continuous monitoring of ventilation in intensive care patients. Clinical observations in patients with pleural effusion show an increase in out-of-phase impedance changes. We hypothesised that out-of-phase impedance changes are a typical EIT finding in patients with pleural effusion and could be useful in its detection.

Transoesophageal echocardiography for the detection and quantification of pleural fluid in cardiac surgical patients

Background: Transoesophageal echocardiography (TOE) can image pleural fluid.Left pleural collections may be easier to detect than right,as the thoracic aorta serves as an acoustic window. Attemptsto quantify pleural fluid using TOE are restricted to a casereport in which volume was predicted by multiplying maximalcross-sectional area (CSA_max) by axial length (AL). A computedtomography (CT) derived formula for quantifying pleural effusionsis maximal effusion depth squared (d²) multiplied by maximaleffusion length. Methods: Eight patients were studied before chest closure following coronarybypass surgery. Fifty millilitre saline aliquots were instilledinto the pleural space until detected by TOE. Saline was theninstilled up to the next 200 ml increment and further 200 mlaliquots added until it spilled from the pleural space. CSA_max,d and AL were measured for each stage and used to calculatepleural fluid volume. Results: Median detection volume (range) was 125 ml (50–200) onthe left and 225 ml (150–300) on the right (P = 0.016).Volume calculated by CSA_max x AL correlated strongly with actualvolume (r² = 0.93 left and 0.92 right) as did volume calculatedby d² x AL (r² = 0.86 left and 0.89 right). Mean differencebetween volume calculated by CSA_max x AL and actual volume was– 51 ml on the left and 45 ml on the right vs –253 ml on the left and – 212 ml on the right for volumecalculated by d² x AL. Conclusions: TOE detects small volumes of pleural fluid on both sides ofthe chest. CSA_max x AL provides a reasonably accurate measureof pleural fluid volume.     

重症急性胰腺炎合并胸腔积液80例临床特征分析

目的分析重症急性胰腺炎(SAP)合并胸腔积液患者的临床特征。方法回顾性分析我院2010年1月~2016年1月收治的80例SAP合并胸腔积液患者的临床资料。结果 80例患者病因以胆源性SAP(58.8%)为主,临床上主要表现为胸闷、气促(57.5%)。胸腔积液出现时间平均为(51.5±38.4)小时,发生部位上以左侧为主(53.8%),常合并腹腔积液(87.5%)。胸腔积液淀粉酶显著高于同步血清淀粉酶[分别为(11914.3±2361.5)U/ml、(486.5±311.3)U/ml,t=42.9,P0.05];胸腔积液白蛋白高于同步血清白蛋白差异[分别为(35.68±8.69)g/L、(30.12±10.30)g/L,t=3.69,P0.05]。Pearson相关性分析结果显示,胸腔积液程度与APACHE-Ⅱ评分(r=0.760,P0.05)呈正相关。全组患者中出现急性肺损伤(ALI)或急性呼吸窘迫综合征(ARDS)30例(37.5%),胰腺假性囊肿8例(10.0%),胰周脓肿3例(3.8%)。胸腔积液平均吸收时间为(9±3)天。结论胸腔积液是SAP常见的并发症之一,其与病情严重程度相关,准确认识其临床特征有助于诊断和治疗。     

Effects of pleural fluid and positive end-expiratory pressure on the measurement of extravascular lung water by the double-indicator dilution technique

The reliability of the double-indicator dilution technique (dye/cold) for measuring extravascular lung water (EVLW) has been studied in lung-healthy dogs after pleural fluid injection of saline (up to 20 ml/kg) during mechanical ventilation at zero and 10 cmH2O (1.0 kPa) end-expiratory pressure (ZEEP and PEEP, respectively). Pleural fluid injection had no effect on EVLW at either ZEEP or PEEP. PEEP induced changes in cardiac output, and reduced both the intravascular (dye) and the thermal indicator volumes, but with no effect on the calculated EVLW. It is concluded that pleural fluid up to 20 ml/kg and ventilation with PEEP of 10 cmH2O (1.0 kPa) do not affect the reliability of the double-indicator dilution technique for measuring extravascular lung water in the dog.