电视胸腔镜手术治疗老年结核性脓胸120例临床分析

目的探讨电视胸腔镜手术在老年结核性脓胸治疗中的价值。方法选择120例老年结核性脓胸患者行电视胸腔镜手术，仅有纤维膜形成者，行脓胸清创术及纤维膜剥离术；病程稍长，已形成纤维板者，则在胸腔镜辅助小切口下行胸膜纤维板剥脱术，观察手术的一般情况、肺功能及并发症发生率。结果手术时间25～150min，平均55rain；术中出血30～1500mL，平均145mL。92例（76．67％）完成胸腔镜手术，22例（18．33％）辅助小切口手术，6例（5．00％）中转开胸。术后胸腔引流3～25d，平均6d。术后近期并发症发生率为29．17％，治疗后均痊愈，无手术死亡及严重并发症。术后1个月肺功能用力肺活量（FVC）、第一秒用力肺活量（FEV1）、肺总量（TLC）较治疗前均明显改善，差异有统计学意义（P〈0．05），且随访无复发病例。结论电视胸腔镜手术或辅助小切口治疗老年结核性脓胸，能达到清除病因、闭合脓腔、恢复肺功能的目的，对老年患者心肺功能影响小，是治疗老年结核性脓胸的最优选择。

Video-assisted thoracic surgery in the treatment of elderly tuberculous empyema,a review of 120 cases

Objective To evaluate the value of video-assisted thoracic surgery （VATS） in the treatment of elderly tuberculous empyema. Methods 120 cases elderly tuberculous empyema by VATS were reviewed. Empyema debridement or decortication of pleurae was applied by using VATS in the early stage. For longer course of disease or pleural tight adhesion cases, video-assisted minithoracotomy（VAMT） was adopted, and the general situation of surgery and the incidence of complications were observed. Results The operation time was 25--150 min （average 55 min）, and hemorrhagic in operation was 30--1 500 mL （average 145 mL）. The procedure was performed completely by VATS in 92 patients （76.67%）, 22 patients （18.33%） by VAMT, and 6 patients （5.00%） by thoracotomy. The duration for chest drainage was 3--25 d （average 6 d）. The rate of postoperative complications was 29.17%, and no surgical death and severe complications were found in all the patients. FVC, FEV1 and TLC improved significantly 1 month later （P 〈0.05）. No recurrence of empyema was observed at the follow-up examination. Conclusion VATS could be the optimal choice for the treatment of elderly pleural empyema, with excellent results in the lesion clearance, the closure of residual cavity, the recovery of pulmonary function, fewer effects on cardiop ulmonary function.