结核性脓胸40例临床分析

目的探讨结核性脓胸的发生原因、临床特点及治疗方法。方法寻找结核性脓胸的发生原因及临床特点;在应用抗痨药物的基础上,应用左氧氟沙星（LOFX）脓腔冲洗、尿激酶胸腔内注入（IPUK）等方法进行介入治疗。结果90%的结核性脓胸病人有渗出性结核性胸膜炎（TEP）病史,早期因胸水较少未行胸穿抽液,或胸穿抽液后胸水已少未再抽液;均为局限性脓胸。结论结核性脓胸主要由于TEP早期未积极胸穿抽液,遗留部分胸水转变所致。除合并支气管胸膜瘘外,局限性脓胸介入治疗效果优异,病人痛苦小,花费少,方法简便,安全可靠,值得临床推广。

Clinical analysis of 40 cases with tuberculous empyemas

Objective To explore the characteristics and therapeutic methods of tuberculous empyemas.Methods A retrospective study was used to analyze 40 cases with tuberculous empyemas for its causes and clinical characteristics of tuberculous empyemas by investigating history,physical examinations and auxiliary examinations.The interventional therapies were applied on 35 patiants with tuberculous empyemas by intrapleural urokinase （IPUK） and levofloxacin （LOFX） after irrgations in purulent cavties with LOFX.Results There were histories of tuberculous exudative pleurisy （TEP） in 90%（36/40）patients with tuberculous empyemas.Thoracentesis and suction of pleural effusion were ignored in the early stages of the acute TEPs.There were atypical symptoms except the patients with tuberculous emypemas combined with active pulmonary tubercuiosis.The pus were white-lactescent in most cases and in the others were yellow and turbid.All caese were cured or patent improvement through the interventional treatment execept 5 patients with bronchopleural fistulas,The cure rate was 74.3% and the total effective rate was 100%.Conclusions The main causes of tuberculous empyemas are lack of thoracentesis and suction of pleural effusion in the early stages of the acute TEPs.The clinical symptoms of tuberculous empyemas are atypical except complications of active pulmonary tuberculosis.Clinical doctors should have high level of awareness on tuberculous empyemas in order to reduce its misdiagnosis and underdiagnosis.With an exception of complication of bronchopleural fistulas with LOFX,urokinases and others,the interventionoal treatment of regional tuberculous empyemas is simple,safe,effective,reliable,inexpensive,painless and well tolerated for patients with tuberculous emypemas.