胸膜滑动征评价青少年自发复发性气胸两种胸膜固定效果

Efficacy of two approaches for pleurodesis evaluated by pleura sliding sign to teenagers' spontaneous recurrent pneumothorax

摘要:

目的 探讨胸膜滑动征评价青少年自发复发性气胸两种胸膜固定效果。方法 收集胸外科胸腔镜下手术治疗青少年自发复发性气胸患者132例，手术随机分为滑石粉胸膜固定组及浓糖摩擦胸膜固定组各66例，术后第3和7天在患侧胸壁取10个超声观察点，观察记录胸膜滑动征阴性病例以评价近期胸膜固定效果。结果 术后超声检查用时（10.5±2.3）min；术后第3天滑石粉组与浓糖摩擦组差异无统计学意义（P =0.182），术后第7天滑石粉组固定效果明显优于浓糖摩擦组（P =0.001）；滑石粉组及浓糖摩擦组各自术后第7天效果均优于第3天（均P <0.05）；滑石粉组术后第3天腋中线及肩胛线胸膜滑动征阴性分布接近，优于腋前线固定效果，至术后第7天腋前线、腋中线及肩胛线胸膜滑动征阴性分布基本相似，而浓糖摩擦组术后第3天和第7天胸膜滑动征阴性分布均表现为腋中线及肩胛线相似，优于腋前线。结论 超声胸膜滑动征检查清晰、直观，是评价胸膜固定效果的理想检测方法，术中采取滑石粉胸膜固定致更早胸腔粘连，效果优于浓糖摩擦固定。

Abstract:

Objective To evaluated the efficacy of two approaches for pleurodesis by pleura sliding sign to teenagers spontaneous recurrent pneumothorax. Methods 132 cases of operation treatment of teenagers' spontaneous recurrent pneumothorax, and divided into two groups to talcum powder pleurodesis and concentrated sugar friction pleurodesis with 66 cases in each group by randomization. Postoperative 3rd and 7th day observed pleura sliding sign negative cases on lpsilateral chest 10 observation points to evaluate the efficacy of pleurodesis. Results Postoperation ultrasonography used average (10.5 ± 2.3) min. Postoperative 3rd day talcum powder group and concentrated sugar friction group had no statistical differences (P = 0.182), while 7th day had obviously statistical differences (P = 0.001). Each group postoperative 7th day the efficacy was obviously better than 3rd day (P < 0.05). Talcum powder group postoperative 3rd day midaxillary line and scapular line negative cases were similar and better than anterior axliary line, while to 7th day three line negative cases were similar. Concentrated sugar friction group postoperative 3rd and 7th day all performed midaxillary line and scapular line negative cases were similar and better than anterior axliary line. Conclusion Ultrasonography pleura sliding sign distinction and intuition were the ideal detective method to evaluate the efficacy of pleurodesis, in operation used talcum powder pleurodesis could produce earlier pleural adhesions and the efficacy was better than concentrated sugar friction.