电视辅助胸腔镜手术早期治疗首次发作原发性自发性气胸的研究——附273例报告

目的:探讨电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在早期干预治疗首次发作原发性自发性气胸(primary spontaneous pneumothorax,PSP)的临床价值.方法:按手术前接受保守治疗方法的不同将273例首次发作PSP患者分为3组,其中,直接行VATS治疗的104例为A组、行胸腔穿刺术抽气治疗后再行VATS治疗的113例为B组、行胸腔闭式引流术治疗后再行VATS治疗的56例为C组.对3组的手术时间、胸腔引流时间、术后持续发热时间、白细胞恢复正常时间、住院时间、气胸复发率、复张后肺水肿发生率、术后漏气发生率、镜视肺大疱检出率、病理肺大疱检出率、胸腔感染率、伤口感染率、中转开胸率及治疗费等指标进行回顾性对比分析.结果:与B组、C组比较,A组的手术时间、胸腔引流时间、术后持续发热时间、白细胞恢复正常时间、住院时间均较短(均为P＜0.05);气胸复发率、复张后肺水肿的发生率、术后漏气发生率、胸腔感染率、伤口感染率及治疗费用均较低(均为P＜0.05);而镜视肺大疱检出率、病理肺大疱检出率和中转开胸率差异无统计学意义.结论:应用VATS早期干预治疗首次发作PSP可明显缩短病人治疗时间,减轻病人痛苦,减少并发症的发生率及降低病人的治疗费用,值得临床推广使用.     

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.     

The Yield and Safety of Thoracentesis in Hematopoietic Stem Cell Transplantation Recipients

The aim of this study was to assess the diagnostic value and safety of thoracentesis in hematopoietic stem cell transplantation (HSCT) recipients. We identified all hospitalized HSCT recipients who underwent thoracentesis from 1998 to 2006. We collected patients’ clinical characteristics, indications for thoracenstesis, the complications of the procedure, and the etiology of the pleural effusion. A total of 50 thoracentesis findings were analyzed. Twenty-six patients underwent allogeneic HSCT, while 24 patients underwent autologous HSCT. The main indications for performing thoracentesis were to rule out infection and document or diagnose malignancy. Pleural effusions were characterized as exudate in 33 patients (66%). A specific diagnosis based on the thoracentesis was made in 13 patients (26%). These were malignancy in nine patients, parapneumonic in three patients, and empyema in one patient. The only documented complication was pneumothorax in five patients. The presence of exudative effusion and underlying solid malignancy were associated with specific diagnosis by thoracentesis (p = 0.0001 and 0.013, respectively). In spite of the tendency of HSCT recipients to develop pulmonary infections, complex parapneumonic effusions are rarely diagnosed by thoracentesis. The rate of complications is comparable to other patient populations.     

肝切除术并发胸腔积液的影响因素分析及诊治体会

目的：探讨肝切除术后并发胸腔积液的影响因素及防治方法。方法：回顾分析123例肝切除术后并发胸腔积液35例患者的临床资料。35例胸腔积液患者均予以保肝、营养支持及利尿治疗;对其中10例中等量以上积液者同时采用B超定位下胸腔穿刺引流治疗,3例合并膈下积液者行膈下积液穿刺引流并加强抗感染治疗,3例合并肺部感染者依据药敏加强抗感染及排痰治疗。结果：本组肝切除术后胸腔积液发生率为28．5％（35／123）;其发生与患者术前肝功能、肝切除量、术中肝门阻断时间及术后腹水量有关（P〈0．05）,与患者的性别、年龄无关（P〉0．05）。35例中,治愈34例;另1例治疗过程中出现肝衰,并发多脏器功能衰竭死亡。结论：胸腔积液是肝切除术后的常见并发症。严格掌握肝切除术适应证、控制肝切除范围,加强术前术后保肝治疗,根据积液量和合并症情况选择合适的治疗方案,对于胸腔积液的预防和治疗具有十分重要的意义。     

重症监护室胸腔积液患者的临床特点及预后研究

目的探讨重症监护病房（ICU）患者胸腔积液的临床特点及预后。方法选择ICU病房92例患者进行回顾性分析,根据住院期间有无胸腔积液分为胸腔积液组和非胸腔积液组,比较两组病人呼吸衰竭的发生率、机械通气时间和预后。并采用微创闭式引流术作胸腔穿刺,观察引流液的颜色、性状、引流量。结果92例患者胸腔积液发生率为41%,胸腔积液组病人呼吸衰竭的发生率、机械通气时间明显高于非胸腔积液组（P〈0.05）。24h胸水引流量180～1600ml,所有胸液外观呈淡血性或淡黄色。实验室检查示渗出液性改变。结论ICU患者胸腔积液发生率较高,胸腔积液组患者呼吸衰竭的发生率高、机械通气时间长,且与预后明显相关。     

Intervencionismo torácico con guía ecográfica

Ultrasonography is a very good tool for guiding different interventional procedures in the chest. It is the ideal technique for managing conditions involving the pleural space, and it makes it possible to carry out procedures such as thoracocentesis, biopsies, or drainage. In the lungs, only lesions in contact with the costal pleura are accessible to ultrasound-guided interventions. In this type of lung lesions, ultrasound is as effective as computed tomography to guide interventional procedures, but the rate of complications and time required for the intervention are lower for ultrasound-guided procedures.     

可移动式多功能体位桌的研制与临床应用效果评价

目的 介绍可移动式多功能体位桌的研制并观察其临床应用效果.方法 自行设计并制作可移动式多功能体位桌.将120例行胸腔穿刺术患者按穿刺顺序号奇数者列为观察组,偶数者列为对照组,每组各60例.对照组采用传统反坐靠背椅的方法行胸腔穿刺术.观察组采用可移动式多功能体位桌行胸腔穿刺术.观察2组患者脉搏、呼吸、动脉血氧饱和度的变化,比较2组患者穿刺时舒适度和满意度.结果 穿刺后2组患者脉搏、呼吸均增快,动脉血氧饱和度均升高,但观察组各项指标显著优于对照组;观察组患者穿刺时舒适度、满意度方面显著优于对照组.结论 可移动式多功能体位桌可减轻患者不适,提高患者术中的耐受力、舒适度及满意度.