64例结核性胸腔积液的治疗体会

目的:探讨结核性胸腔积液治疗方法及效果。方法:对我科2004～2006年收治的64例结核性胸腔积液患者的临床诊治资料进行回顾性分析。结果:5例结核性胸腔积液患者B超提示液性暗区<1.5cm未定位抽胸水,予抗结核药物治疗,治疗后2～4周胸水基本吸收。7例结核性胸腔积液患者B超提示液性暗区在1.5～3cm予胸穿针穿刺抽液,并予抗结核药物治疗,平均2周后胸水基本吸收。40例结核性胸腔积液患者B超提示液性暗区>3cm予中心静脉导管留置引流胸水,并予抗结核药物治疗。平均3～5天胸水基本吸收后拔管。8例结核包裹性胸腔积液伴胸膜明显增厚患者予胸穿针每次抽液后注入尿激酶10万U,并予抗结核及支持对症治疗,胸膜粘连明显减轻。4例胸水反复出现,予胸膜粘连术后胸水不再产生。结论:根据胸腔积液程度分别采用药物治疗,胸穿针穿刺抽液,中心静脉导管留置引流胸水,胸腔内注入尿激酶,B超引导下抽液及胸膜粘连术,均取得较满意的效果。

Therapeutic experience of 64 cases of tuberculous pleural effusion

Objective:To investigate the therapeutic way and curative effect of tuberculous pleural effusion.Methods:The clinical data of diagnosis and treatment in 64 cases of tuberculous pleural effusion from 2004 to 2006 in our department were analysed retrospectively.Results:The hydrothorax in 5 cases,whose liquidity shadow less than 1.5 cm suggested by B-mode ultrasound was not fixed to extract hydrothorax,was basically absorbed in 2 to 4 weeks after being given anti-tuberculous therapy.The hydrothorax in 7 cases,whose liquidity shadow from 1.5 to 3 cm suggested by B-mode ultrasound was given puncture to extract hydrothorax with thoracic puncture needle,was basically absorbed in an average of 2 weeks after being given anti-tuberculous treatment.The hydrothorax in 40 cases,whose liquidity shadow greater than 3 cm suggested by B-mode ultrasound was given drainage by indwelling the central vein catheter,was basically absorbed in an average of 3 to 5 days after being given anti-tuberculous treatment.The tuberculous encysted dropsy with pleura conglutination in 8 cases,whose pleural encysted cavity was given puncture with thoracic puncture needle for injecting urokinase 100,00 units every time after extracting hydrothorax,was distinctly eased after being given anti-tuberculous treatment.The hydrothorax in 4 cases,whose recurrent hydrothorax was given pleura congluatination operation,did not occur.Conclusion:Using medicine treatment,puncturing by thoracic puncture needle,drainaging by central vein catheter,injecting urokinase and pleura conglutination operation should be respectively based on the different degrees of the pleural effusion.