结核性气胸治疗探讨

目的 探讨结核性与非结核性气胸在临床表现方面的差异,寻找结核性气胸治疗的最佳方案。方法 回顾分析98例结核性气胸住院治疗资料,并与同期82例特发性气胸相比较;对比分析几种治疗方法的临床应用及其效果,并与有关文献比较。结果 98例结核性气胸治愈94例,死亡4例,全部死于呼吸衰竭,病死率4.26％。低于国内有关报道的9.2％和12％。15例肺压缩<30％的闭合性气胸采用休息和／或胸穿抽气治愈,平均痊愈时间11.3d;肺压缩≥30％的闭合性气胸、交通性气胸和张力性气胸采用胸腔插管持续闭式引流,共83例,治愈77例.治愈率92.8％。引流时间平均13.8d,明显长于文献报道的4d和7.3d。4例交通性气胸负压吸引未见效果,改用胸膜腔注药治愈。2例剖胸手术成功,占2.1％,低于文献报道的6.2％和35.6％。结论 治疗结核性气胸应加强原发病治疗和支持治疗,并根据气胸不同类型采取不同的方法。闭合性气胸可采用休息或抽气疗法,交通性和张力性气胸均应采用胸腔插管持续闭式引流,必要时加用胸膜腔注药。适当延长引流时间能提高治疗成功率,减少不必要剖胸手术或胸腔镜手术。

Study of therapy of pneumothorax caused by tuberculosis

jective To study clinical different between the tuberculous and nontuberculous pneumothorax,and to search the best therapy. Methods 98 cases of pneumothorax caused by tuberculosis were analyzed retrospectively. Results 94 cases of pneumothorax caused by tuberculosis were cured ,4 cases died of exhaustion of respiration. The rate of death of the disease was 4. 26%. 15 cases of closed pneumothorax crushed lung <30% were cured by resting and drawing gas out. 83 eases of closed pneumothorax crushed lung > 30% .opening pneumothorax and high pressure pneumothorax,were treated by inserting tube into thorax and persistent closed drainage,77 cases being cured, the rate of cure 92. 8%. The average time of persistent closed drainage was 13. 8 days. The time is longer than the report of relative literature. 4 cases of negative pressure drainage were of no effect. 2 cases of thoracotomy were successful. Conclusion Treating the pneumothorax caused by tuberculosis should consolidate the treatment of original disease and supportive treatment. Closed pneumothorax may be treated by resting and drawing gas out. Opening pneumothorax and high pressure pneumothorax should use inserting tube into thorax and persistent closed drainage. Prolonging properly the time of persistent closed drainage may increase successful rate and lessen non - essential thoracotomy.