结核性脓胸电视胸腔镜胸膜纤维板剥脱术适应证初探

Indication of video-assisted thoracoscopic decortication in treatment of tuberculous empyema

摘要:

目的 探讨电视胸腔镜（VATS）胸膜纤维板剥脱术治疗结核性脓胸的疗效，并初步探讨其手术适应证。方法 2010年12月-2015年12月筛选60例确诊为结核性脓胸患者，进行了VATS胸膜纤维板剥脱术。在胸腔镜下吸净脓液，分离粘连，清除脓腔内壁上的结核肉芽组织和干酪坏死物，剥除增厚的壁、脏层胸膜纤维板。术后充分引流，同时全身抗结核治疗。结果 该组患者手术均顺利，全部一次手术治愈，无围手术期死亡，无术中、术后并发症。随访2个月～5年，肺复张良好，无复发。结论 VATS胸膜纤维板剥脱术治疗结核性脓胸安全、有效、微创。笔者认为影像学表现胸膜增厚在1.0 cm以内、无明显钙化和肺内无严重病变等为其手术适应证。

Abstract:

Objective To evaluate the efficacy of decortication by video-assisted thoracic surgery (VATS) in patients with tuberculous empyema, and discuss its indications. Methods 60 patients with tuberculous empyema who underwent decortication by VATS for surgical management from December 2010 to December 2015 were included. Under a thoracoscope, we cleaned up the pus, separated adhesions, scraped granulation tissues and caseous necrosis on the inner wall of the abscess cavity, and stripped the thickened fiberboard of the parietal and visceral pleurae. After the procedure, sufficient drainage and antituberculosis therapy were carried out. Results All the patients in this group were operated successfully. All the patients were cured without perioperative death and complications. No recurrence of empyema was observed at the follow-up examination from 2 months to 5 years, and suffered pulmonary reexpansions were better. Conclusions The decortication by VATS for tuberculous empyema is safe, effective, minimally invasive. The imaging manifestations of pleural thickening in 1 cm, no obvious calcification, no serious lesions in the lungs are the indications for the operation.