宁新忠++++++夏照华++++++王海江

[摘要] 目的 探讨胸膜纤维板剥脱术在慢性结核性脓胸中的应用效果及安全性。 方法 选取本院2008年7月～2013年12月手术救治的58例慢性结核性脓胸患者作为研究对象，所有患者术前均给予抗结核及抗感染治疗，以胸膜纤维板剥脱术作为手术方式，术后持续治疗，增强呼吸功能锻炼，有效促使肺不张。 结果 58例慢性结核性脓胸患者手术均顺利完成，术中出血量为（700±45） ml。经胸膜纤维板剥脱术治疗后，患者脓腔消失，病情改善较佳，无死亡病例；术后未发生肺漏气、肺不张、感染、出血等并发症。病情完全改善者50例（86.2%），病情好转者6例（10.3%），脓胸复发者2例（3.5%）。 结论 胸膜纤维板剥脱术治疗慢性结核性脓胸患者的效果显著，可有效改善患者的肺功能，与抗结核等相关治疗相结合，可降低复发率，提高患者的生存质量。

[关键词] 胸膜纤维板剥脱术；慢性结核性脓胸中；安全性；临床价值

[中图分类号] R561.6[文献标识码] B[文章编号] 1674-4721（2014）06（a）-0181-03

The application effect and the safety analysis of pleural fibreboard stripped in chronic tuberculous pyothorax

NING Xin-zhong XIA Zhao-hua WANG Hai-jiang

Thoracic Surgery Department,the Third People′s Hospital of Shenzhen City,Shenzhen 518112,China

[Abstract] Objective To explore the application effect and the safety analysis of pleural fibreboard stripped in chronic tuberculous pyothorax. Methods 58 patients with chronic tuberculous pyothorax in our hospital from July 2008 to December 2013 were selected as the research object,all patients with preoperative anti-tuberculosis and anti-infection treatment,with pleural fibreboard stripped as operation method,after continuous treatment,strengthen the respiratory function exercise,effectively promote atelectasis. Results 58 cases of chronic tuberculous pyothorax patients surgery were all completed,the intraoperative blood loss was (700±45) ml.Patients with the treatment of pleural fibreboard stripped,pus cavity disappeared,had better improvement,no deaths.No postoperative pulmonary leakage,atelectasis,infection,bleeding and other complications.The illness completely improve in 50 cases (86.2%),condition improved in 6 cases (10.3%),pyothorax recurrence in 2 cases (3.5%). Conclusion The effect of pleural fibreboard stripped surgery for the treatment of chronic tuberculous pyothorax patients is significantly,can effectively improve the patient′s lung function,combined with tuberculosis and other related treatment,can reduce the recurrence rate,improve the quality of the survival of patients.

[Key words] Pleural fibreboard stripping technique;Chronic tuberculous pyothorax;Security;Clinical value

慢性脓胸患者长期存在积脓，纤维素大量沉积，使胸壁内陷，且肋骨间隙发生改变，随着肋骨的聚拢，肋骨逐渐改变为三角形状。患者脊柱开始侧弯，胸膜纤维板增厚，严重限制膈肌并固定膈肌位置，患者呼吸受到影响，其呼吸功能逐渐减退。同时不断收缩的纤维板使纵隔移至患侧，严重影响患者的血液循环，易出现杵状指。慢性胸脓肿患者受慢性感染的侵害比较严重，易发生脏器功能障碍，致使支气管胸膜瘘形成，特殊情况下穿透胸膜向外侵犯，常常出现哑铃状脓肿。……