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目的探讨CT分期对结核性脓胸纤维板剥脱手术时机的指导意义. 方法 收集2014年11月至2016年11月武汉市肺科医院收治的因结核性脓胸行纤维板剥脱手术治疗的56例患者,根据CT特点分为进展期(作为进展组;23例)、稳定期(作为稳定组;33例),对两组患者的病程、术前抗结核药物治疗时间、手术持续时间、术中出血量、术后24 h引流量、术后带管时间、手术治愈率、病理改变等情况[数据以“中位数(四分位数间距)”表示]进行统计分析. 结果 稳定组患者病程[23.6(17.1~30.0)周]、术前抗结核药物治疗时间[17.1(8.6~24.3)周]均明显长于进展组[分别为12.9(8.6~15.0)周、10.7(1.7~12.9)周],差异均有统计学意义(U值分别为137.50、159.50,P值分别为0.014、0.049);进展组手术时间[330.0(307.5~395.0) min]、术中出血量[700(500~800) ml]、术后24 h引流量[600(480~785) ml]、术后带管时间[29(14~35) d]均明显长(高)于稳定组[分别为270.0(240.0~330.0) min、300(200~400) ml、420(350~520) ml、7(5~8) d],差异均有统计学意义(U值分别为141.00、55.00、105.50、55.50,P值分别为0.027、<0.001、0.009、<0.001).稳定组的手术治愈率(84.8%,28/33)明显高于进展组(26.1%,6/23),差异有统计学意义(x2=19.62,P<0.001).在病理学改变方面,进展组的干酪样坏死比率(82.6%,19/23)明显高于稳定组(39.4%,13/33),差异有统计学意义(x2=8.65,P=0.003);稳定组玻璃样改变及坏死的比率(84.8%,28/33)明显高于进展组(30.4%,7/23),差异有统计学意义(x2=17.12,P<0.001). 结论 CT分期可作为纤维板剥脱手术时机的参考依据,进展期患者无特殊情况应延缓进行手术治疗.“,”Objective To investigate the effects of CT features on the timing of tuberculous empyema surgery. Methods According to the CT characteristics, we grouped 56 patients with tuberculous empyema, who stayed in Wuhan Pulmonary Hospital and received surgical treatment by stripping of fibrous plates from November 2014 to November 2016, into progress period (23 cases) and stable period (33 cases).The following data of the patients in each group were collected and analyzed: the duration of disease, the treatment duration with anti-tuberculosis (TB) drugs, the duration of the surgery, intraoperative blood loss during operation;24 hours postoperative drainage, time for carrying the drainage tube, the cure rate of operation, the pathological examination results, etc. Results The duration of disease (23.6 (17.1-30.0) weeks) and the previous treatment duration with anti-TB drugs (17.1 (8.6-24.3) weeks) in the stable period group patients were significantly longer than those in the progress period group patients (12.9 (8.6-15.0) weeks, U=137.50, P=0.014;10.7 (1.7-12.9) weeks, U=159.50, P=0.049) respectively.The duration of operation (330.0 (307.5-395.0) min), intraoperative blood loss (700 (500-800) ml), 24 hours postoperative drainage (600 (480-785) ml) and the time for carrying drainage tube (29 (14-35) d) in the progress period group patients were significantly longer or higher than those in the stable period group patients (270 (240-330) min;U=141.00, P=0.027;300 (200-400) ml, U=55.00, P<0.001;420 (350-520) ml, U=105.50, P=0.009;7 (5-8) d, U=55.50, P<0.001) respectively.The cure rate of operation in the stable period group (84.8%, 28/33) was obviously higher than that in the progress period group (26.1%, 6/23;x2=19.62, P<0.001).As for the pathological changes, the proportion of caseous necrosis in the progress period group (82.6%, 19/23) was significantly higher than that in the stable period group (39.4%, 13/33;x2=8.65, P=0.003);but proportion of the hyaline change and necrosis in the progress period group (30.4%, 7/23) was significantly lower than that in the stable period group (84.8%, 28/33;x2=17.12, P<0.001). ConclusionThe grouping of tuberculous empyema by the characteristics of CT can be used as a reference for the selection of the proper time of stripping of fibrous plates;the operation should be postponed if the patients are in the progress period and without the special situation.