人工液胸在内科胸腔镜术前准备中的应用价值

doi:10.19983/j.issn.2096-8493.20220004

摘要/Abstract

摘要：

目的探讨人工液胸在内科胸腔镜术前准备中的临床应用价值及安全性。方法: 回顾性分析2014年5月至2019年11月因胸腔积液或胸膜疾病入住湖南省胸科医院并行内科胸腔镜手术的163例患者的临床资料。以2014年5月至2016年12月术前未行人工液胸的48例患者作为对照组,以2017年1月至2019年11月术前行人工液胸的115例患者作为观察组。分析观察组实施人工液胸的成功率及并发症发生情况,并比较两组患者进行内科胸腔镜操作的有效率和肺损伤情况。结果: 观察组实施人工液胸操作的成功率为100.0%(115/115),注水过程中共计有27例(23.5%)出现轻中度咳嗽、呼吸困难、胸壁皮下包块、注水侧胸腔局部疼痛等不适,经吸氧、平卧休息、调整体位及呼吸频率、停止操作等处置后均缓解,未出现与人工液胸操作相关的皮下气肿、血胸、感染、针道转移、空气栓塞等严重并发症。观察组内科胸腔镜的病理直接确诊率[92.2%(106/115)]明显高于对照组[72.9%(35/48)],操作有效率[97.4%(112/115)]明显高于对照组[85.4%(41/48)],而肺损伤率[4.3%(5/115)]明显低于对照组[18.8%(9/48)],差异均有统计学意义(χ²=10.757,P=0.001;χ²=6.481,P=0.011;χ²=7.206,P=0.007)。 结论: 内科胸腔镜术前实施人工液胸准备可安全有效地探知术前胸腔情况,并能够有效提高操作有效率,扩大手术操作空间,减少操作过程中的肺损伤。

关键词: 胸腔积液, 胸腔镜检查, 评价研究, 水气胸, 人工

Abstract: Objective: To explore the clinical value and safety of artificial hydrothorax in preoperative preparation of medical thoracoscopy.Methods: The clinical datas of 163 patients who hospiyalized in the Endoscopy Center of Hu’nan Chest Hospital and underwent medical thoracoscopic surgery because of pleural effusion or pleural disease from May 2014 to November 2019 were retrospectively analyzed. From January 2017 to November 2019, 115 pleural effusion patients who underwent artificial hydrothorax before the medical thoracoscopy were selected as the observation group. From May 2014 to December 2016, 48 pleural effusion patients who did not undergo artificial pleural thoracic examination before medical thoracoscopy were selected as the control group. The success rate and the complications in the observation group were analyzed, and the effective rate and lung injury of medical thoracoscopy were compared between the two groups.Results: The success rate of artificial hydrothorax in the observation group was 100.0% (115/115). A total of 27 cases (23.5%) had mild to moderate cough, dyspnea, subcutaneous mass in the chest wall, and local pain in the chest cavity during the water injection process. After oxygen inhalation, supine rest, adjust the body position and respiratory rate, stopping the operation, and other disposal, all patients were relieved, and there were no serious complications such as subcutaneous emphysema, hemothorax, infection, needle tract transfer, and air embolism related to the operation of artificial hydrothorax. In the observation group, the direct pathological diagnosis rate of medical thoracoscopy was significantly higher than that in the control group (92.2% (106/115) vs. 72.9% (35/48), χ ²=10.757, P=0.001), the operational efficiency was significantly higher than that in the control group (97.4% (112/115) vs. 85.4%(41/48), χ ²=6.481, P=0.011), and the lung injury rate was significantly lower than that of the control group (4.3% (5/115) vs. 18.8% (9/48), χ ²=7.206, P=0.007).Conclusion: The implementation of artificial hydrothorax before medical thoracoscopy can safely and effectively detect the thoracic cavity, improve the operation efficiency, expand the operation space, reduce lung injury during the operation.

Key words: Pleural effusion, Thoracoscopy, Evaluation studies, Hydropneumothorax, artificial

中图分类号:

R521
R560.4

卢志斌, 罗莉, 罗林紫, 肖阳宝. 人工液胸在内科胸腔镜术前准备中的应用价值[J]. 结核与肺部疾病杂志, 2022, 3(2): 131-136. doi: 10.19983/j.issn.2096-8493.20220004

LU Zhi-bin, LUO Li, LUO Lin-zi, XIAO Yang-bao. Application value of artificial hydrothorax in preoperative preparation of medical thoracoscopy[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(2): 131-136. doi: 10.19983/j.issn.2096-8493.20220004

图/表 9

表1

内科胸腔镜术前评估指征在两组患者间的分布情况

术前指征	合计	观察组(115例)	对照组(48例)	统计检验值	P值
性别[例(构成比,%)]				χ²=1.411	0.235
男性	126(77.3)	86(74.8)	40(83.3)
女性	37(22.7)	29(25.2)	8(16.7)
年龄(岁, $x ¯$ ±s)	49.0±16.4	47.6±16.8	52.3±15.0	t=0.685	0.409
超声测量胸膜厚度[例(构成比,%)]				χ²=3.199	0.074
增厚	61(37.4)	38(33.0)	23(47.9)
未增厚	102(62.6)	77(67.0)	25(52.1)
CT测量胸膜厚度[例(构成比,%)]				χ²=1.467	0.226
增厚	127(77.9)	87(75.7)	40(83.3)
无增厚	36(22.1)	28(24.3)	8(16.7)
超声评估胸腔粘连[例(构成比,%)]				χ²=1.111	0.292
有	95(58.3)	64(55.7)	31(64.6)
无	68(41.7)	51(44.3)	17(35.4)
CT评估胸腔粘连[例(构成比,%)]				χ²=0.574	0.449
有	119(73.0)	82(71.3)	37(77.1)
无	44(27.0)	33(28.7)	11(22.9)

表1

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