目的通过回顾性分析结核性胸腔积液患者临床资料,评估外科早期手术治疗的时机,避免结核性脓胸形成.方法 回顾性分析我院自2015年1月至2016年7月住院的结核性胸腔积液患者601例,年龄(45.3±7.3)岁,男464例,女137例.采用胸腔穿刺疗法(进行常规胸腔穿刺,并留置静脉引流细管进行持续的胸腔积液引流)461例(简称“穿刺组”),手术疗法140例(简称“手术组”);并发肺结核171例,未并发肺结核430例;营养正常380例,营养不良221例;根据患者胸膜增厚程度分级,一级232例,二级287例,三级 82例.结合治疗方法及相关影响因素,利用多元logistic回归分析各种影响因素,得出早期进行外科手术干预治疗的临床证据.结果 手术组相对于穿刺组,单因素分析:手术组治愈率为94.3%(132/140),穿刺组治愈率为84.8%(391/461)(x2=7.7,P=0.005);多因素logistic回归分析:手术与穿刺组两种治疗方法比较,OR值为3.60,95%CI值为2.31~4.89.手术组相对穿刺组对于治愈率有着明显优势.对不同级别胸膜增厚的两组治疗结果,在控制其他影响因素下进行多因素logistics回归分析,显示手术疗法相对于穿刺疗法在胸膜增厚一级、二级、三级中的的OR值(95%CI值)分别是1.20(0.99~1.27)、2.01(1.75~2.27)、5.81(2.95~8.71), 说明手术组相对于穿刺组随着胸膜增厚级别的增加,优势度更加明显.结论 对于胸膜增厚一级的胸腔积液患者采取胸腔穿刺治疗较好,胸膜增厚达二、三级时推荐对患者实施手术治疗,以提高治愈率.“,”Objective By retrospectively analyzing the clinical information of the patients with tuberculous pleural effusion, to evaluate the timing of early surgical treatment of tuberculous pleurisy. Methods The information and data of 601 patients, who were diagnosed as tuberculous pleurisy and stayed at our hospitals from January 2015 to July 2016, were collected and analyzed.The average age of those patients was (45.3±7.3).The number of male and female patients was 464 and 137 respectively.The thoracentesis treatment was given to 461 patients (called “thoracentesis group”) while the surgical treatment was given to 140 patients (called “surgery group”);171 patients were accompanying with pulmonary tuberculosis (PTB) while 430 patients were not;380 patients were in good nutrition while 221 patients were in malnutrition.All patients were classified into different grade levels (from Grade 1 to Grade 3) according to the degree of thickened pleura: 232 patients were at Grade 1 level, 287 patients were at Grade 2 level and 82 patients were at Grade 3 levle.The related influencing factors to the two group patients who received different treatments were evaluated using multivariable logistic regression and the clinical evidences about the intervention treatment of early surgery in tuberculous pleurisy patients were obtained. Results The results of single-factor analysis showed that the cure rate of the patients in surgery group vs thoracentesis group was 94.3% (132/140) vs 84.8% (391/461) (x2=7.7, P=0.005);the results of multivariable logistic regression analysis showed that OR=3.60 (95%CI=2.31-4.89) between the two groups.The cure rate of the patients in the surgery group was significantly higher than that in the thoracentesis group.The variables of gender and nutritional status were controlled, and then the multivariable logistic regression analysis was conducted among patients in different treatment groups and different grade level of thickened pleura groups, the results were as follows: OR in the Grade 1 level group, Grade 2 level group and Grade 3 level group was 1.20 (95%CI=0.99-1.27), 2.01 (95%CI=1.75-2.27) and 5.81 (95%CI=2.95-8.71) respectively.Compared to the thoracentesis group, the ORs in the surgery group increased from Grade 1 level to the Grade 3 level and it showed that the surgery therapy gave more benefits to the patients in the higher grade levels of thickened pleura than thoracentesis treatment. ConclusionThe better treatment outcomes can be achieved in the tuberculous pleurisy patients at the grade 1 level of thickened pleura by using thoracentesis treatment, while the surgical treatment is more effective in those patients at the grade 2 or 3 level of thickened pleura and to improve their cure rate.