尿激酶治疗结核性包裹性胸腔积液不同时间后手术治疗的疗效分析

目的探讨尿激酶治疗结核性包裹性胸腔积液后外科手术治疗的最佳时机。方法结核性包裹性胸腔积液患者120例。依据接受手术前尿激酶治疗时间的不同将120例患者分为两组,A组60例,为常规抗结核治疗并给予胸腔注射尿激酶治疗1个月左右接受手术治疗;B组60例,为常规抗结核治疗并给予胸腔注射尿激酶治疗2个月左右接受手术治疗。比较两组患者的临床疗效。结果 A组患者手术时间为(145.72±38.48)分钟,术中出血量(332.96±108.03)ml,术后24小时引流量(264.67±101.37)ml,引流管放置时间为(4.49±1.22)天;B组患者分别为(149.14±39.06)分钟、(356.64±106.31)ml、(262.38±97.80)ml和(4.53±1.26)天,两组比较差异无统计学意义(P0.05)。A组患者的治疗总有效率、肺活量(VC)增加量和最大通气量(MVV)增加量分别为86.67%、(0.32±0.10)ml和(13.24±2.45)ml,B组患者分别为96.67%、(0.47±0.14)ml和(17.03±3.75)ml,两组比较差异有统计学意义(P0.05)。两组患者术后复发率比较,差异无统计学意义(P0.05)。A组不良反应发生率显著高于B组,两组间比较差异有统计学意义(P0.05)。结论结核性包裹性胸腔积液患者在抗结核及胸腔注射尿激酶穿刺抽液治疗2个月左右疗效改善仍不明显时,接受手术治疗可获得较好的临床效果。

Effects of different urokinase administration on the surgical outcomes of tuberculous encapsulated pleural effusion

Objective To investigate the appropriate urokinase treatment course for surgical out-comes of tuberculous pleural effusion. Methods A total of 120 cases of tuberculous pleural effusion were enrolled. The patients were divided into two groups according to the different course of urokinase treat-ment. In group A,60 patients accepted surgery after routine anti-tuberculosis treatment and intrapleural in-jection of urokinase for 1 month;in group B,60 patients accepted surgery after conventional anti-tuberculo-sis treatment and intrapleural injection of urokinase for 2 months. The curative effects were compared be-tween groups. Results There were no significant differences in operation time,intraoperative bleeding, postoperative drainage,extubation time,and recurrence between group A and B(P > 0. 05). There were significant differences in total efficiency(86. 67% vs 96. 67% ),VC improvement[(0. 32 ± 0. 10)ml vs (0. 47 ± 0. 14)ml],and MVV improvement[(13. 24 ± 2. 45)ml vs(17. 03 ± 3. 75)ml]between group A and B(P < 0. 05). The incidence of adverse reactions in group A was significantly higher than that of group B(P < 0. 05). Conclusion If there is no significant improvement of efficacy in anti-tuber-culosis treatment and intrapleural injection of urokinase treatment after 2 months,surgery can obtain better therapeutic effects.