猪尾巴导管在单孔胸腔镜肺肿瘤手术中应用的有效性评估:基于倾向性评分匹配法的研究

目的评估猪尾巴导管在单孔胸腔镜肺肿瘤手术中应用的有效性。方法回顾性分析2020年1月至12月上海交通大学医学院附属仁济医院东院接受单孔胸腔镜肺肿瘤手术的患者共441例,根据是否放置猪尾巴导管分为胸管组和猪尾巴管组,通过倾向性评分匹配法进行1∶1匹配,对比两组患者围手术期的各项指标。结果匹配后每组143例配对成功,匹配后两组间基线特征无统计学差异。对比两组围手术期指标发现,猪尾巴管组患者术后3天胸腔引流总量显著多于胸管组(375.49 ml对285.03 ml,P<0.001),术后两周复查CT示胸腔积液量显著少于胸管组(131.77 ml对178.84 ml,P=0.032),两组术后疼痛评分、引流天数及住院天数无明显统计学差异。结论加放猪尾巴导管可有效改善单孔胸腔镜肺肿瘤术后胸腔引流情况,且不增加患者术后疼痛,不延长胸腔引流及住院天数。     

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。     

Etiology of Pleural Effusions: Analysis of More Than 3,000 Consecutive Thoracenteses

ObjectiveTo investigate the etiology of pleural effusions (PE) in adults and the accuracy of pleural fluid (PF) cytology and cultures in malignant and infectious PE, respectively.Patients and methodsRetrospective analysis of all consecutive patients with PE undergoing diagnostic thoracentesis during the last 19 years in a university hospital.ResultsThe leading causes of PE among the 3077 patients were cancer (27%), heart failure (21%), pneumonia (19%), tuberculosis (9%), abdominal surgery (4%), pericardial diseases (4%) and cirrhosis (3%). Tuberculosis was the most common etiology in patients <34 years of age (52%), whereas heart failure predominated in octogenarians (45%). The most common primary tumors in malignant PE were lung (37%) and breast (16%) tumors. The overall accuracy of PF cytology was 59%, although it was significantly lower in mesotheliomas (27%) and squamous cell lung cancer (25%). In infectious PE, only 30% of cultures yielded positive results, a percentage which increased two-fold (66%) in purulent fluids (empyemas). Viridans streptococci were the most commonly isolated pathogens (25.5%). The sensitivity of solid media cultures of PF for Mycobacterium tuberculosis was low (18.5%).ConclusionsThree quarters of patients with PE in whom a diagnostic thoracentesis was indicated had cancer, heart failure, pneumonia or tuberculosis. PF cytology and cultures give false negative results in a significant number of cases.     

Pleural Effusion and Sarcoidosis: An Unusual Combination

Pleural involvement in sarcoidosis is uncommon and appears in several forms. To document the incidence and characteristics of pleural effusion in sarcoidosis patients, a review of the cases diagnosed in our center between January 2001 and December 2012 was carried out. One hundred and ninety-five patients with sarcoidosis were identified; three (two men and one woman) presented with unilateral pleural effusion (1.5%): one in the right side and two in the left. Two were in stage II and one was in stage IV. The pleural fluid of the two patients who underwent thoracocentesis was predominantly lymphocytic. One of these patients presented chylothorax and the other had high CA-125 levels. In general, these effusions are lymphocyte-rich, paucicellular, serous exudates (sometimes chylothorax) and contain proportionally higher levels of protein than LDH. Most cases are treated with corticosteroids, although it may resolve spontaneously.     

硬质胸腔镜与可弯曲电子胸腔镜在不明原因胸腔积液中的应用价值

目的对比硬质胸腔镜与可弯曲电子胸腔镜在胸腔积液病因诊断中的价值。方法收集1992年4月~2013年11月在我院所有内科胸腔镜检查98例的资料,2011年前79例行硬质胸腔镜检查,以后19例行可弯曲电子胸腔镜检查。比较2组确诊率及操作并发症等方面的差异。结果硬质胸腔镜组镜下表现对恶性肿瘤的阳性预测值为89.1%(41/46),可弯曲胸腔镜组为75.0%(9/12),2组间差异无显著性(χ2=0.631,P=0.427)。胸腔镜活检病理与最终诊断方面,硬质胸腔镜组的总体确诊率为62.0%(49/79),对恶性肿瘤的确诊率为87.8%(43/49);可弯曲胸腔镜组的总体确诊率为63.2%(12/19),对恶性肿瘤的确诊率为100%(9/9),2组间差异无显著性(总体:χ2=0.008,P=0.927;恶性肿瘤:P=0.576)。硬质胸腔镜组2例(2.5%)胸腔镜活检病理结果与临床最终诊断不一致,但2组间差异无显著性(P0.05)。2组均未出现严重并发症。结论硬质胸腔镜与可弯曲电子胸腔镜对不明原因胸腔积液的诊断价值相当,对恶性胸腔积液有良好的诊断价值,两者均具有良好的安全性。     

腭裂患儿手术年龄与分泌性中耳炎恢复的相关性分析

目的从腭裂患儿分泌性中耳炎恢复的角度探讨适宜手术年龄。方法对不同年龄段腭裂患儿于术前和术后半年进行鼓膜检查,声导抗测试,脑干听性诱发电位测试（ABR）。并对年龄构成相儿配的正常儿童进行同样测试。结果腭裂患儿分泌性中耳炎的指标与正常儿童比较有显著差异;各年龄段腭裂患儿分泌性中耳炎的指标比较,差异无统计学意义（P〉0．05）。患儿术前术后指标比较,差异有统计学意义（P〈0．05）。6～18个月组与18个月至3岁组、3～7岁组比较,差异有统计学意义（P〈0．05）,而18个月至3岁组和3～7岁组比较,差异无统计学意义（P〉0．05）。结论腭裂手术对中耳功能的恢复、听力损失的改善起着积极的作用,于术时年龄越小,分泌忡中耳炎的恢复越好,6～18个月是较为适宜的手术年龄。     

中西医结合治疗癌性胸腔积液的临床体会

 目的　观察中西医结合辨证施治治疗胸腔积液的疗效。方法　治疗组 3 0例用顺铂 (DDP)胸腔内灌注 ,并与中药辨证配合治疗 ;对照组以DDP胸腔灌注治疗。结果　治疗组总有效率 83 .3 % ,对照组总有效率 70 .0 % ,(P <0 .0 5 )。主要不良反应为发热 ,恶心呕吐等。结论　中西医结合治疗恶性胸腔积液能提高疗效 ,降低毒副反应。     

可弯曲电子内科胸腔镜在不明原因胸腔积液诊断中的应用价值

目的探讨可弯曲电子内科胸腔镜在不明原因胸腔积液诊断中的应用价值。方法采用尖端可弯曲电子内科胸腔镜（LTF-240型）对92例不明原因的胸腔积液患者进行检查,并回顾性分析其临床资料。结果92例患者均成功实施了胸腔镜检查,胸腔镜下病理组织活检确诊恶性肿瘤30例、结核性胸膜炎57例、慢性炎症5例。肿瘤和结核病理结果确诊率为94．6％。恶性胸腔积液主要表现为结节样改变,部分病灶融合成肿块。而结核性胸膜炎主要为胸膜弥漫性充血肿胀,结节病灶细小呈卵石样改变,可见坏死物覆盖。92例胸腔镜检查仅1例出现胸膜反应,无严重并发症发生。结论可弯曲电子内科胸腔镜检查安全、有效、易操作。     

胸腔内注入尿激酶联合化疗治疗多房性包裹性恶性胸腔积液

目的：探讨胸腔内注入尿激酶联合化疗治疗多房性包裹性恶性胸腔积液的临床应用和疗效。方法：对46例合并多房性包裹性恶性胸腔积液的晚期癌症患者,先经皮穿刺中心静脉导管胸腔置管,后经导管注入尿激酶（20～30）万U（5000U/kg）融化包裹及分隔纤维组织,使胸水引流顺畅,尽可能放尽胸水后行胸腔内化疗。结果：46例患者胸腔注入尿激酶后均能使胸水通畅,干净,及时胸腔内化疗,继而全身化疗;治疗后CR（完全缓解）31例,PR（部分缓解）10例,NC（无效）5例;胸水控制总有效率89.13%。CR病人住院期控制胸水平均时间为37d;平均完全缓解期为11.7个月。所有患者对尿激酶胸腔注射有良好耐受性。结论：胸腔内注入尿激酶联合化疗治疗多房性包裹性恶性胸腔积液方法简便,较常规胸穿减少了穿刺次数,减少了患者痛苦及治疗经费;此法胸水控制完全缓解率高,控制胸水时间短;与常规胸穿相比患者胸膜肥厚粘连程度轻,肺功能恢复良好。值得临床推广应用。     

胸腔镜介导下微波和钳夹治疗多房性结核性胸腔积液

目的评价内科胸腔镜介导下微波和钳夹治疗多房性结核性胸腔积液的疗效和安全性。方法将60例多房性结核性胸腔积液患者随机分为3组,在正规抗结核治疗的基础上,A组采用内科胸腔镜介导下微波和钳夹治疗,B组胸腔内注入尿激酶治疗,C组为常规胸腔穿刺抽液,比较三组抽液效果、临床疗效、胸膜肥厚、肺功能的影响及不良反应。结果A组抽液效果明显优于B、C两组,临床疗效和对胸膜肥厚、肺功能的影响明显好于C组（P〈0.05）,与B组差异无显著性（P〉0.05）,未见严重并发症。结论内科胸腔镜介导下微波和钳夹治疗为多房性结核性胸腔积液提供了一种新的辅助治疗手段,具有疗效好,胸水吸收快,操作简单、安全,并发症少、患者恢复快等优点。