| Objective:(1)to study the thoracoscope in the early period of tuberculous pyothorax clinical intervention therapy compared to the superiority of conservative treatment.(2)the pyothorax fiberboard forming stage,the superiority of thoracoscope treatment and its limitations.Methods:(1)selection of 60 cases of patients with tuberculous pyothorax,early diagnosis of tuberculous pleurisy and after thoracic cavity closed drainage of pleural effusion of residual of patients,41 cases of men and women in 19 cases,with an average age of29 years old,patients with history of less than three weeks,randomly divided into two groups,the depth of colour to exceed examination pleural effusion is greater than3.0 cm,2 groups of patients in the treatment process to give 2 hrze / 4 hr standard anti-tuberculosis treatment scheme.Observation group patients give VATS pyothorax dissection meanwhile;The control group patients chest injection of urokinase.Observation group with 3 days after the surgery,1 week,3 months,6 months to observe the time node.Control group patients for chest injection of urokinase,repeat(1-3 times),until the drainage pipe daily to reduce drain below 30 ml,pull out the tube,pull out the tube after 3 days,1 week,3 months,6 months to observe the time node.In the first observation time node mainly observe the patients' clinical symptoms: fever,shortness of breath,chest pain to improve the situation;The second and third: node main observation,observation time 2 groups of patients chest CT manifestations,chest pa/performance.Observe 4 nodes,as well as contrast colour to exceed 2 groups of patients with chest CT performance,at the same time fight n/med tuberculosis treatment,medication time for evaluation.Conclusion:thoracoscope treatment the patient at the first time watch nodes: fever period,patients with chest pain symptoms of shortness of breath period was better than control group(P < 0.05).Second,observing residue node in patients with pleural effusion thoracoscopy group exists obvious difference with control group,the thoracoscope treatment group showed less residual pleural effusion was significantly better than that of control group(P < 0.05).The third observation nodes,degree of patients with pleural thickening,thoracoscope group was obviously lighter than the control group(P < 0.05).Fourth node contrast,two groups of patients with chest CT shows thoracoscope pleura hypertrophy group patients with significantly lower than the control group,the illness recovery was better than control group,(P < 0.05)and some patients once pleural cavity is very difficult to find the trace of the lesion.Thoracoscope treatment group anti-tuberculosis treatment time is shortened,control group patients and anti-tuberculosis dose(mainly refers to drug varieties).(2)to select 60 patients with tuberculous pyothorax the intermediate stage,chest CT examination show that there are wrapped pleural effusion,pleural fibreboard has been formed,but less than 5 mm,the thickness of thoracic not deformation,Bing Bian Chu ribs not seen obvious narrow,pleural cavity tuberculosis turn into chronic infection status,most of the patients have no fever,night sweats,such as tuberculosis poisoning performance,some patients exist mild shortness of breath,chest tightness,and blunt chest pain and other clinical manifestations.Patients were randomly divided into 2groups,treated with surgery;Line group VATS pyothorax expurgation + fiber board stripped off and the control group conventional incision thoracotomy surgery(pyothorax dissection meanwhile + fiber board stripped).Postoperative 1 week and 3months to observe node.The main status of patients with postoperative atelectasis,pleural effusion residues,state recovery of 3 months lesions in the chest.Conclusion:mid for tuberculous pyothorax,VATS surgery(fiberboard stripped),satisfaction with atelectasis,pleural disease recovery relatively regular open thoracic surgery,no obvious difference,but thoracoscope surgery trauma is small,generally take 2 holes or puckering method,no more than 5 cm,the total length of incision thoracotomy surgery requires the length of incision and the vomica range,even when necessary need to cut part of the rib to line operation,in addition if the vomica,irregular operation have to according to the vomica contorts the change in the process of wound contorts,expand the trauma colleagues,affect the appearance,especially in cases of patients with psychological influence on teenagers.So middle of surgical treatment of tuberculous pyothorax,VATS has obvious advantages,relative to the conventional thoracotomy surgical treatment,reduce trauma surgery can effectively at the same time to achieve.(3)History of patients with stage 3.In view of the 3 tuberculous pyothorax,generally more than 3 months,chest CT examination showed obvious fiberboard,with lateral thoracic in chest wall collapse,ribs,the appearance of the gap significantly narrowed,fiberboard and dirty layer pleural adhesions close right now,which has been formed by nourishing blood vessels,spin off easily when bleeding,and some patients because lung tissue pressure for a long time,some patients even after parts peeling fibreboard,atelectasis,pleural still has formed.Need additional local thoracic surgery,patients with lesions in this stage we had applied try thoracoscope treatment,some patients ribs within excessively narrow,which have to remove part of the frame,rib after bed for hole operation,other patients chest has shown an independent state,with normal pleural fibreboard separated by thick,thoracoscope operation inconvenience,if found fiber board in the operation cannot be stripped or even fiberboard atelectasis after peeling bad,still have residual lesions in the chest place line requires local thoracic cavity change shape,as the thoracoscope can not play a role.So the third phase of patients with tuberculous pyothorax thoracoscope treatment should be discreet,quite a number of treatment in patients with thoracoscope not fully play a role in the process,still need regular open thoracic surgery. |
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