胸腔镜手术对结核性胸膜炎患者免疫功能及临床疗效的影响

Impact of thoracoscopic surgery on immune function and clinical efficacy in patients with tuberculous pleurisy

摘要:

目的 探究胸腔镜手术对结核性胸膜炎患者免疫功能及临床疗效的影响。方法 回顾性分析2022年7月－2024年1月青岛市公共卫生临床中心接收，并施行外科手术的85例结核性胸膜炎患者的临床资料。按不同术式将患者分为开胸组（22例）和胸腔镜组（63例），比较两组围手术期指标、疼痛程度、血清炎症因子水平、肝肾功能、营养相关指标、临床疗效和不良反应。结果 胸腔镜组术中出血量和引流量明显少于开胸组，住院时间、手术时间和带管时间明显短于开胸组，差异均有统计学意义（P < 0.05）；胸腔镜组术后24 h静息和活动状态下的视觉模拟评分法（VAS）评分明显低于开胸组，差异均有统计学意义（P < 0.05）；胸腔镜组术后24 h的C反应蛋白（CRP）明显低于开胸组，差异有统计学意义（P < 0.05）；胸腔镜组术后24 h肌酐（Cr）、天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平明显低于开胸组，差异均有统计学意义（P < 0.05）；胸腔镜组术后24 h的预后营养指数（PNI）、白蛋白、血红蛋白和淋巴细胞水平明显高于开胸组，差异均有统计学意义（P < 0.05）；胸腔镜组总有效率明显高于开胸组，差异有统计学意义（P < 0.05）；两组术后降钙素原（PCT）和不良反应总发生率比较，差异均无统计学意义（P > 0.05）。结论 对于结核性胸膜炎患者，胸腔镜手术在减轻炎症反应、减少术中出血量和改善营养状况等方面，较开胸手术更具优势，且安全、有效。值得应用于临床。

Abstract:

Objective To explore the impact of thoracoscopic surgery on the immune function and clinical efficacy of patients with tuberculous pleurisy.Methods A retrospective analysis was conducted on the clinical data of 85 patients with tuberculous pleurisy who received and underwent surgical operations from July 2022 to January 2024. The patients were divided into the thoracotomy group (22 cases) and the thoracoscopic group (63 cases) according to different surgical methods. The perioperative indicators, pain degree, levels of serum inflammatory factors, liver and kidney functions, nutrition-related indicators, clinical efficacy and adverse reactions of the two groups were compared.Results The intraoperative blood loss and drainage volume in the thoracoscopic group were significantly less than those in the thoracotomy group, and the hospital stay, operation time and catheter insertion time were significantly shorter than those in the thoracotomy group. The differences were statistically significant (P < 0.05). The visual analogue scale (VAS) scores of the thoracoscopic group at rest and during activity 24 hours after surgery were significantly lower than those of the thoracotomy group, and the differences were statistically significant (P < 0.05). The postoperative 24 h C-reactive protein (CRP) in the thoracoscopic group was significantly lower than that in the thoracotomy group, and the difference was statistically significant (P < 0.05). The levels of postoperative creatinine (Cr), aspartate transaminase (AST), and alanine transaminase (ALT) 24 h after surgery in the thoracoscopic group were significantly lower than those in the thoracotomy group, and the differences were statistically significant (P < 0.05). The prognostic nutritional index (PNI), albumin, hemoglobin and lymphocyte levels 24 h after surgery in the thoracoscopic group were significantly higher than those in the thoracotomy group, and the differences were statistically significant (P < 0.05). The total effective rate of the thoracoscopic group was significantly higher than that of the thoracotomy group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in procalcitonin (PCT) and the total incidence of adverse reactions after surgery between the two groups (P > 0.05).Conclusion For patients with tuberculous pleurisy, thoracoscopic surgery has more advantages than thoracotomy in reducing inflammatory responses, minimizing intraoperative blood loss, and improving nutritional status, and it is safe and effective. It is worth applying in clinical practice.