微管胸腔闭式引流在结核性胸腔积液治疗中的应用

Objective To observe the effect and safety of pleural effusion treated by closed thoracic drainage with micro-catheter. Methods A total of 64 cases with pleural effusion were randomly divided into conventional therapy group ( control group ) and closed thoracic drainage with micro-catheter group ( treatment group) , each group including( 32 cases ). Control group were treated with drainage of thoracic puncture interruptedly while treatment group treated by closed thoracic drainage with micro-catheter. Results Both two therapeutic methods could reduce pleural effusion, but obvious effective rate of treatment group was higher than that of control group( P ＜ 0.05 ). Meanwhile, the rate of pleural reaction and treatment cost in treatment group were lower than that in control group. Conclusion Closed thoracic drainage with micro-catheter was effective, lower treatment cost and lower complications. Moreover, it could reduce medical risk.     

超声引导胸膜活检术在胸膜病变诊断中的应用价值

目的 探讨超声引导胸膜活检术对胸膜病变检出的阳性率和安全性.方法 对我院自2006年2月至2009年3月诊断为胸膜疾病并行超声引导胸膜活检术109例患者的临床资料进行回顾性分析.结果 109例中98例成功,11例穿刺失败.109例胸膜活检中提示结核性胸膜炎34例、慢性炎症18例、腺癌21例、鳞癌9例、小细胞癌4例、不明部位的转移癌5例、间皮瘤5例,13例穿刺所得病理诊断为骨骼肌组织和纤维脂肪组织.术后并发症包括气胸2例,胸膜反应3例,出血1例.结论 超声引导胸膜活检术的准确性、灵活性、实用性较强,是较理想的检查方法.

Abstract：

Objective To observe the positive rate and safety of the biopsy of pleura receive ultrasonic punctures in the pleura disease.Methods Retrospective analysis of 109 patients diagnosed of disease of pleura with needle biopsy of pleura from 2006 to 2009.Results One hundred and nine cases,tuberculous pleurisy was 30.8%.chronic iaflammation was 16.5%,adenocarcinoma was 19.3%,squamous cell carcinoma was 8.3%,small cell carcinoma was 3.7%.unknown parts of metastatic carcinoma was 4.1%,mesothelioma 5 cases was 4.6%.skeletal muscle tissue and fibrous adipose tissue was 11.9%.Malignant pleural biopsy positive rate was 40.5%and pathological diagnosis rate was 88.1%.Regarding postoperative complications included pneumothorax (1.8%),pleural reaction(2.8%)and bleeding(0.9%).Conclusion Ultrasound localization of pleural needle biopsy is an effective diagnostic method for pleura disease.     

前列腺素E1联合血浆置换治疗慢性重型肝炎的临床研究

Objective To investigate the curative effect, timing and feasibility of prostaglandin E1 combined plasma exchange in treatment of chronic severe hepatitis. Methods Eighty-eight patients with chronic severe hepatitis were randomly divided into treatment group and control group. The treatment group was given prostaglandin E1 combined plasma exchange treatment based on the comprehensive treatment of internal medicine. Control group only had given the internal medicine comprehensive treatment. Results The symptoms and signs of the treatment group were improved after treatments, especially with total bilirubin, cholinesterase, prothrombin activity, NH3 ( P ＜ 0.01,P ＜ 0.05 ). After treatment, except for albumin, the others indicators of the two groups had significant difference ( P ＜ 0.05). Follow-up for three months, the total effective rate of the treatment group was 69.6% ( 32cases ), early effective rate was 79.3% (23 cases), mid-term effective rate was 64.3% (9 cases) were all significantly higher than those of control group [47.6% (20 cases), 55.6% ( 15 cases), 38.5% (5 cases)] (P ＜ 0. 01 ).Conclusion Prostaglandin E1 combined with plasma exchange in treatment of chronic severe hepatitis can improve the liver function and survival rate significantly.     

前列腺素E1联合血浆置换治疗慢性重型肝炎的临床研究

Objective To investigate the curative effect, timing and feasibility of prostaglandin E1 combined plasma exchange in treatment of chronic severe hepatitis. Methods Eighty-eight patients with chronic severe hepatitis were randomly divided into treatment group and control group. The treatment group was given prostaglandin E1 combined plasma exchange treatment based on the comprehensive treatment of internal medicine. Control group only had given the internal medicine comprehensive treatment. Results The symptoms and signs of the treatment group were improved after treatments, especially with total bilirubin, cholinesterase, prothrombin activity, NH3 ( P ＜ 0.01,P ＜ 0.05 ). After treatment, except for albumin, the others indicators of the two groups had significant difference ( P ＜ 0.05). Follow-up for three months, the total effective rate of the treatment group was 69.6% ( 32cases ), early effective rate was 79.3% (23 cases), mid-term effective rate was 64.3% (9 cases) were all significantly higher than those of control group [47.6% (20 cases), 55.6% ( 15 cases), 38.5% (5 cases)] (P ＜ 0. 01 ).Conclusion Prostaglandin E1 combined with plasma exchange in treatment of chronic severe hepatitis can improve the liver function and survival rate significantly.     

乳腺癌肝转移的不同治疗方法比较

目的 比较手术治疗、全身化疗、全身化疗联合肝动脉化疗栓塞对乳腺癌肝转移的疗效.方法 回顾性分析1996年1月至2008年10月52例乳腺癌肝转移临床资料,根据治疗方法分为手术组(12例)和单纯全身化疗组(22例)和全身化疗联合肝动脉化疗栓塞组(18例),分析3组的疗效及预后,比较不同治疗方法的疗效.结果 52例乳腺癌术后肝转移患者,全组治疗有效27例(51.9%),手术组有效4例(33.3%),单纯全身化疗组有效11例(50.0%),全身化疗联合肝动脉化疗栓塞组有效12例(66.6%).1、2、3年生存率手术治疗组分别为25.0%(3例)、8.3%(11例)、0,单纯全身化疗组分别为31.8%(7例)、13.6%(3例)、9.1%(2例),全身化疗联合肝动脉化疗栓塞组分别为44.4%(8例)、33.3%(6例)、11.1%(2例),全身化疗联合肝动脉化疗栓塞组生存率明显优于手术治疗组和单纯全身化疗组(P<0.05).结论 采用全身化疗联合肝动脉化疗栓塞治疗乳腺癌术后肝转移疗效较好,值得临床进一步推广.

Abstract：

Objective To explore the efficacy of hepatectomy and chemotherapy and transcatheter arterial chemoembolization plus chemotherapy on breast cancer complicated with liver metastases. Methods Clinical features of 52 breast cancer patients with liver metastases from 1996 to 2008 were analyzed retrospectively. Fifty-two patients were divided into surgery group (group Ⅰ) , systemic chemotherapy group (group Ⅱ) and transcatheter arterial chemoembolization (TACE) plus chemotherapy group (group Ⅲ). The efficacies of different treatment approaches were compared. Results The total responsive rate was 51.9% for among all patients. TACE plus chemotherapy produced a significantly higher partial response rate 66. 6% in comparison with 50. 0% (11 cases) of systemic chemotherapy and 33.3% ( 4 cases ) of hepatectomy ( P < 0. 05 ). The median survival time was 16 months ( 2-50 months)and 1-year, 2-year, 3-year survival rate in three groups was 25.0% , 8. 3% , 0( group I ) , 31. 8% , 13.6%, 8.9%(group Ⅱ)and 44.4%, 33.3%, ll.l%(group Ⅲ), respectively. The survival time of group Ⅲ was the longest (P <0.05). Conclusion Chemotherapy plus TACE may be an effective and safe treatment for liver metastases after breast cancer.     

中药外治法用于盆腔炎性疾病后遗症的疗效探讨

Objective To explore the curative effect of treating sequelae of pelvic inflammatory disease with chinese medicine external therapy.Metbods 178 cases that diagnosed as sequelae of pelvic inflammatory disease were randomly divided into control group,test Group 1,and test Group 2.Control group were treated by with broad-spectrum antibioticos for three cycles cycles intravenously;and applying Chinese medicine retention enema and Chinese medicine abdominal hot compress on test Group 1 for three cycles;test Group 2 was used the same methods as group 1 for six cycles.Comparing the comprehensive effect,cure rate and the recurrence rate within the six-month after the treatment.Results Comparing the integrated effect of the three groups;test groups 2 was the optimal(P＜0.01).The cure rates of control group,test Group 1,and test Group 2 were19%34%61%respective;and the recurrence rates were 55%,35%,12%respectively.There were statistically significant differences among these three groups(P＜0.01);test group 2 had the highest cure rate and the lowest recurrence rate;and control group had the opposite results.Conchusion Applying Chinese medicine retention enema and abdominal Chinese medicine hot compress on sequelae of pelvic inflammatory disease for 6 cycles has remarkable treatment effect.     

中药外治法用于盆腔炎性疾病后遗症的疗效探讨

Objective To explore the curative effect of treating sequelae of pelvic inflammatory disease with chinese medicine external therapy.Metbods 178 cases that diagnosed as sequelae of pelvic inflammatory disease were randomly divided into control group,test Group 1,and test Group 2.Control group were treated by with broad-spectrum antibioticos for three cycles cycles intravenously;and applying Chinese medicine retention enema and Chinese medicine abdominal hot compress on test Group 1 for three cycles;test Group 2 was used the same methods as group 1 for six cycles.Comparing the comprehensive effect,cure rate and the recurrence rate within the six-month after the treatment.Results Comparing the integrated effect of the three groups;test groups 2 was the optimal(P＜0.01).The cure rates of control group,test Group 1,and test Group 2 were19%34%61%respective;and the recurrence rates were 55%,35%,12%respectively.There were statistically significant differences among these three groups(P＜0.01);test group 2 had the highest cure rate and the lowest recurrence rate;and control group had the opposite results.Conchusion Applying Chinese medicine retention enema and abdominal Chinese medicine hot compress on sequelae of pelvic inflammatory disease for 6 cycles has remarkable treatment effect.     

中药外治法用于盆腔炎性疾病后遗症的疗效探讨

Objective To explore the curative effect of treating sequelae of pelvic inflammatory disease with chinese medicine external therapy.Metbods 178 cases that diagnosed as sequelae of pelvic inflammatory disease were randomly divided into control group,test Group 1,and test Group 2.Control group were treated by with broad-spectrum antibioticos for three cycles cycles intravenously;and applying Chinese medicine retention enema and Chinese medicine abdominal hot compress on test Group 1 for three cycles;test Group 2 was used the same methods as group 1 for six cycles.Comparing the comprehensive effect,cure rate and the recurrence rate within the six-month after the treatment.Results Comparing the integrated effect of the three groups;test groups 2 was the optimal(P＜0.01).The cure rates of control group,test Group 1,and test Group 2 were19%34%61%respective;and the recurrence rates were 55%,35%,12%respectively.There were statistically significant differences among these three groups(P＜0.01);test group 2 had the highest cure rate and the lowest recurrence rate;and control group had the opposite results.Conchusion Applying Chinese medicine retention enema and abdominal Chinese medicine hot compress on sequelae of pelvic inflammatory disease for 6 cycles has remarkable treatment effect.     

不同方案治疗卵巢上皮性癌的疗效比较

Objective To explore different methods on the efficacy of epithelial ovarian cancer.Methods The patients with epithelial ovarian cancer,a total of 265 cases,who was treated were selected and divided into A,B groups.Its surgical,chemotherapy and efficacy were compared.It was basically the same between the two surgical.On chemotherapy,A group was given PAC program mainly,B group Was given TA program mainly.Results Diameter of residual tumor lesions>2 cm respectively accounted for 29.2%.14.2%.The difference of clinical remission rate,partial remission rate was not significant.Effective rates were respectively 51.7% and 81.4%(P<0.05).To group A,the survival rates of 1-year,2-years,3-years,4-years,5-years were respectively 90.2%,86.9%,62.7%,45.8%,32.7%:The median survival period and relapse-free survival time was respectively 37.9 months and 17.4 months.To group B,the survival rates of 1-year,2-years,3-years,4-years,5-years were respectively 94.3%、91.1%、68.7%、56.4%、44.2%;The median survival period and relapse-free survival time wag respectively 50.5 months and 32.2 months.The difference of 5-years survival rate,median survival,relapse-free survival of the two groups was statistically significant(P<0.01 or 0.05).Conclusions The size of postoperative residual disease and the chemotherapy im-paeted the efficacy of epithelial ovarian cancer.TC chemotherapy was superior to PAC chemotherapy.     

不同方案治疗卵巢上皮性癌的疗效比较

Objective To explore different methods on the efficacy of epithelial ovarian cancer.Methods The patients with epithelial ovarian cancer,a total of 265 cases,who was treated were selected and divided into A,B groups.Its surgical,chemotherapy and efficacy were compared.It was basically the same between the two surgical.On chemotherapy,A group was given PAC program mainly,B group Was given TA program mainly.Results Diameter of residual tumor lesions>2 cm respectively accounted for 29.2%.14.2%.The difference of clinical remission rate,partial remission rate was not significant.Effective rates were respectively 51.7% and 81.4%(P<0.05).To group A,the survival rates of 1-year,2-years,3-years,4-years,5-years were respectively 90.2%,86.9%,62.7%,45.8%,32.7%:The median survival period and relapse-free survival time was respectively 37.9 months and 17.4 months.To group B,the survival rates of 1-year,2-years,3-years,4-years,5-years were respectively 94.3%、91.1%、68.7%、56.4%、44.2%;The median survival period and relapse-free survival time wag respectively 50.5 months and 32.2 months.The difference of 5-years survival rate,median survival,relapse-free survival of the two groups was statistically significant(P<0.01 or 0.05).Conclusions The size of postoperative residual disease and the chemotherapy im-paeted the efficacy of epithelial ovarian cancer.TC chemotherapy was superior to PAC chemotherapy.     

结核性包裹性胸膜炎治疗方法探讨

目的探讨治疗结核性包裹性胸膜炎的新方法。方法将选入的189例包裹性胸膜炎患者用随机数字表法分为3组：A组65例,采用中心静脉导管置入胸膜腔内引流胸腔积液,每Et通过引流管注入尿激酶10万U;B组66例,只采用中心静脉导管置入胸膜腔内引流胸腔积液;C组58例,每周2—3次用常规胸穿方法抽胸腔积液。3组患者的化疗方案均为2HREZ／10HR。比较3组临床疗效。结果治疗2个月时显效率、有效率及总有效率A组分别为89．2％（58例）、9．2％（6例）、98．5％（64例）;B组分别为81．8％（54例）、12．1％（8例）、93．9％（63例）;C组分别为8．6％（5例）、58．6％（34例）、67．2％（39例）。治疗12个月时A、B、C3组的总有效率分别为100％、90．9％、82．7％。A组总有效率与B、C两组比较差异有统计学意义（P〈0．05）。结论用中心静脉导管胸膜腔内置入加注入尿激酶是一种治疗包裹性胸膜炎的理想方法。     

护理干预对结核性胸膜炎患者中心静脉导管胸腔引流效果及治疗依从性的影响

目的：探讨护理干预对结核性胸膜炎患者中心静脉导管胸腔引流的效果及其对抗结核治疗依从性的影响。方法将72例接受中心静脉导管胸腔引流的结核性胸膜炎患者随机分为干预组和对照组,实施不同的护理措施,观察两组胸腔引流的效果及其抗结核治疗的依从性。结果干预组一次性置管成功率92．1％（35／38）;置管引流后,平均胸水消失时间（4．0±1．2）d,总住院天数（14．6±3．3）d;上述指标和对照组比较差异均有统计学意义（P ＜0．05或0．01）。出院时,干预组知识达标32例（84．2％,32／38）,患者满意度评分（92．5±4．2）分,上述指标和对照组比较差异均有统计学意义（P ＜0．001）。服药依从性评估显示,干预组依从性高者达到50．0％（10／38）,两组服药依从性比较差异有统计学意义（P ＜0．05）。结论对实施中心静脉导管胸腔引流的结核性胸膜炎患者进行综合护理干预,能改善胸腔引流效果,提高患者治疗依从性,有利于从根本上提高抗痨治疗的效果。     

胸膜腔注射尿激酶治疗结核性胸膜炎疗效分析

目的 观察胸膜腔注射尿激酶对结核性渗出性胸膜炎的治疗效果。方法91例结核性胸膜炎并胸腔积液患者随机分为治疗组（40例）和对照组（51例）,2组均予以全身化疗及抗炎治疗,治疗组在此基础上加用尿激酶于胸膜腔内注射。观察2组患者胸水量、胸水吸收时间及治疗效果。结果胸水15d以内吸收者,治疗组72．5％（29／40）,对照组为37．3％（19／51）;胸膜肥厚粘连发生率,治疗组35．0％（14／40）,对照组为72．5％（37／51）。2组比较差异有统计学意义（P〈0．05）。结论胸膜腔注射尿激酶治疗结核性渗出性胸膜炎有较大的临床应用价值。     

胸膜腔闭式引流治疗结核性脓胸方法研究

目的比较胸膜腔闭式引流治疗结核性脓胸时胸膜腔注入不同药物的疗效,探讨治疗结核性脓胸的理想方法。方法将选入的结核性脓胸患者分为2组：A组（中心静脉导管胸膜腔置入引流加胸膜腔内注入尿激酶法）32例,采用中心静脉导管置入胸膜腔内引流胸液,每日通过引流管注入尿激酶;B组（中心静脉导管胸膜腔置入引流加胸膜腔内注入异烟肼法）32例,采用中心静脉导管置入胸膜腔内引流胸液,每日通过引流管注入异烟肼;2组患者的化疗方案均为2HREZ／10HR。比较2组临床疗效。结果治疗2、12个月时显效率、总有效率A、B2组比较差异有统计学意义（P〈0．05）。结论用中心静脉导管胸膜腔内置入加注入尿激酶是一种治疗结核性脓胸的理想方法。     

胸腔闭式引流加尿激酶注入对结核性胸膜炎粘连的影响

目的探讨胸膜腔内尿激酶注入对结核性渗出性胸膜炎所致胸膜肥厚和粘连的影响。方法将结核性渗出性胸膜炎患者随机分为胸腔闭式引流加尿激酶组（A组,80例）、胸腔闭式引流组（B组,80例）和胸腔穿刺抽液组（C组,80例）。A组采用中心静脉导管置入胸腔持续引流胸腔积液,待胸腔积液减少时,尿激酶100000U加生理盐水20ml注入胸膜腔,夹闭导管10h后放开引流,隔天1次,3次为1个疗程。其他治疗相同。结果胸膜肥厚和粘连发生率A组8.75％明显低于B组30.00％和C组52.50％,差异有统计学意义（P〈0.05）;C组并发症的发生率高于A组和B组（P〈0.01）;A组注药后胸腔积液中白细胞数及蛋白量短期内均较注药前明显下降（P〈0.01）,而B组、C组治疗前后无明显变化（P〉0.05）。结论胸腔引流加注入尿激酶能有效降低胸膜肥厚和粘连发生的机会和程度,无不良反应。     

胸腔内注入尿激酶治疗结核性包裹性胸膜炎临床疗效分析

目的 观察胸腔内注射尿激酶治疗包裹性结核性胸膜炎的疗效.方法 在常规治疗下,治疗组76例结核性包裹性胸腔积液患者胸穿抽液后胸腔内注射尿激酶100 000 U,对照组52例不注射.结果 治疗组76例,显效61例,有效13例,总有效率97.4%;对照组52例,显效27例,有效14例,总有效率78.8%.结论 规则抗痨下,胸内注射尿激酶治疗包裹性结核性胸腔积液可加速胸水的吸收,增加引流量,减轻胸膜增厚度黏连.     

结核性胸膜炎的中药辅助治疗观察

目的：探讨中药在辅助治疗结核性胸膜炎的作用。方法：将66例初治结核性胸膜炎患者随机分为治疗组与对照组,每组33例。两组均给予2SHRZ／4HR方案,治疗组同时予中药治疗。观察胸水吸收、胸膜肥厚和胸膜粘连等临床症状的改善情况,并与对照组相比较。结果：治疗2个月后治疗组胸水消失时间短于对照组（P〈0．05）,胸膜肥厚和胸膜粘连发生率低于对照组（P〈0．05）。结论：中西医结合治疗结核性胸膜炎可提高临床疗效。     

中西医结合治疗结核性渗出性胸膜炎的临床应用体会

目的观察中西医结合治疗结核性渗出性胸膜炎的临床疗效。方法将82例患者随机分为中西医结合治疗组及对照组,每组41例,对照组采用西医抗痨治疗,治疗组在西医治疗的基础上加用中药治疗;两组均治疗4周后评效。结果对照组41例患者中,治愈18例,有效18例,无效5例,总有效率为80.0%。中西医结合治疗组41例患者中,治愈27例,有效12例,无效2例,总有效率95.1%;治疗组总有效率优于对照组。结论中西医结合治疗结核性渗出性胸膜炎临床效果较好,复发率低,值得临床推广应用。     

结核性包裹性胸膜炎临床治疗观察

目的 探讨结核性包裹性胸膜炎的最佳治疗方法.方法 将60例结核性包裹性胸膜炎患者分为观察组和对照组,各30例,观察组在胸腔穿刺抽液后胸腔注入尿激酶10万U、地塞米松10 mg、异烟肼0.3g,对照组胸腔内注入异烟肼0.3g.2组患者的抗结核化疗方案均为2HRE(S) Z/10HRE.疗程1年.每周2次常规胸腔穿刺,比较2组临床疗效.结果 胸腔穿刺次数、胸腔积液消失时间、临床症状消失时间观察组总有效率分别为100.0％ (30/30)、96.7％ (29/30)、100.0％ (30/30);对照组总有效率分别为60.0％(18/30)、70.0％ (21/30)、50.0％ (15/30).胸膜无粘连增厚观察组22例(73.3％)、对照组10例(33.3％).2组疗效对比,观察组均高于对照组,差异有统计学意义(P＜0.05).结论 胸腔内注入尿激酶、地塞米松、异烟肼能溶解胸腔积液房隔,明显增加下一次胸腔穿刺抽水量,减少抽胸腔积液次数,缩短患者不适症状消失时间,减轻或消除胸膜肥厚粘连的发生.     

异烟肼联合地塞米松胸腔注入治疗结核性胸腔积液疗效观察

目的探讨异烟肼联合地塞米松胸腔注入治疗结核性胸腔积液的临床疗效及安全性。方法选择本科收治的结核性胸腔积液患者80例,随机分为对照组及治疗组各40例,均行常规抗结核治疗,对照组在此基础上予常规胸穿抽液治疗,治疗组抽液后行胸腔注入异烟肼联合地塞米松治疗。结果经比较,异烟肼联合地塞米松胸腔注入治疗后患者平均住院时间及胸腔积液消退时间较对照组明显缩短,在联合胸腔注入给药治疗后临床症状改善明显,临床总有效率达95%,差异具有统计学意义（P〈0.05）;经胸腔注入治疗后,治疗组胸膜粘连肥厚发生率明显低于对照组,其他严重不良反应发生率也低于对照组,二者差异有统计学意义（P〈0.05）。结论异烟肼联合地塞米松胸腔注入治疗结核性胸腔积液效果肯定,可促进胸腔积液吸收,防止胸膜粘连肥厚,安全有效。