气管切开导管作为胸壁套管在气管镜代胸腔镜中的应用
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摘要
目的探讨一次性气管切开导管作为胸壁套管在电子支气管镜代胸腔镜的可行性。方法收集2015年1月-2015年10月在该院呼吸内科就诊的86例应用电子支气管镜代胸腔镜诊断不明原因胸腔积液患者的资料。其中,男59例(68.6%),女27例(31.4%),年龄15~83岁,平均(49.00±20.00)岁。86例患者随机分成两组,其中一组采用一次性气管切开导管作为胸壁套管,另外一组采用常规内科胸腔镜胸壁套管,比较两者的标本阳性率、手术操作时间、套管价格和不良反应等。结果气管切开导管组43例中确诊40例(93.0%),包括肺癌胸膜腔转移8例,结核性胸膜炎31例,脓胸1例,3例诊断不明(7.0%);常规胸壁套管组43例中确诊33例(76.7%),包括肺癌胸膜腔转移4例,结核性胸膜炎29例,10例诊断不明(23.3%);两组比较,差异有统计学意义(P<0.05)。气管切开导管组手术操作时间为(23.86±2.45)min,常规胸壁套管组手术操作时间(29.88±3.67)min,两者相比,差异有统计学意义(P<0.05)。两组并发症发生率无明显差异。结论利用一次性气管切开导管作为胸壁套管,可缩短手术时间,提高诊断阳性率,降低费用,运用于电子支气管镜代胸腔镜中具有可行性,值得广泛应用。
Objective To investigate the feasibilty of the disposable tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope. Methods 86 patients with effusion of unknown origin undergoing medical thoracoscopy from January 2015 to October 2015, 59 male(68.6 %) and 27 female(31.4 %), mean age(49.00 ± 20.00)years(15 ~ 83) years, were randomly divided into two groups, Tracheostomy tube group(group T) and Conventional chest tube group(group C). Group T uses disposable cannula tracheostomy tube as trocar, and group C received conventional medical thoracoscopy chest tube. Then compare the positive rate of pathological diagnosis, operation time, inspection fees, and other adverse reactions between the two groups. Results 40 cases(93.0%) in group T were confirmed diagnosis, including 8 cases of lung pleural metastasis, 31 cases of erculous pleurisy, 1 case of empyema, while 4 cases of unknown diagnosis(7.0 %). 33 cases(76.7 %) in group C were confirmed diagnosis, including 4 cases of lung pleural metastasis, 29 cases of tuberculous pleurisy, while 10 cases of unknown diagnosis(23.3 %). The difference was statistically significant between the two groups(P < 0.05). Operative time in group T was(23.86 ± 2.45) minutes, while in group C was(29.88 ± 3.67) minutes, the difference was statistically significant(P < 0.05). While the complication rate was no significant difference. Conclusions It is demonstrated that the disposable tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope which can shorten the operation time, improve the diagnosis rate, reduce costs, worthy of promoting.
Objective To investigate the feasibilty of the disposable tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope. Methods 86 patients with effusion of unknown origin undergoing medical thoracoscopy from January 2015 to October 2015, 59 male(68.6 %) and 27 female(31.4 %), mean age(49.00 ± 20.00)years(15 ~ 83) years, were randomly divided into two groups, Tracheostomy tube group(group T) and Conventional chest tube group(group C). Group T uses disposable cannula tracheostomy tube as trocar, and group C received conventional medical thoracoscopy chest tube. Then compare the positive rate of pathological diagnosis, operation time, inspection fees, and other adverse reactions between the two groups. Results 40 cases(93.0%) in group T were confirmed diagnosis, including 8 cases of lung pleural metastasis, 31 cases of erculous pleurisy, 1 case of empyema, while 4 cases of unknown diagnosis(7.0 %). 33 cases(76.7 %) in group C were confirmed diagnosis, including 4 cases of lung pleural metastasis, 29 cases of tuberculous pleurisy, while 10 cases of unknown diagnosis(23.3 %). The difference was statistically significant between the two groups(P < 0.05). Operative time in group T was(23.86 ± 2.45) minutes, while in group C was(29.88 ± 3.67) minutes, the difference was statistically significant(P < 0.05). While the complication rate was no significant difference. Conclusions It is demonstrated that the disposable tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope which can shorten the operation time, improve the diagnosis rate, reduce costs, worthy of promoting.
引文
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[9]林涛,林爱俊,彭桂芳.电子支气管镜代替胸腔镜在疑难胸腔积液中的诊治价值[J].中国药物与临床,2011,11(2):177-178.
[10]杨印楼,姜鲁宁.支气管镜代胸腔镜检查对原因不明性胸膜病的诊断价值[J].中国内镜杂志,2008,14(10):1056-1067.
[11]陈永倖,程宏宁,罗美娟,等.纤维支气管镜代胸腔镜在胸腔积液诊断中的应用[J].江苏医药,2010,36(18):2122-2123.
[12]杨安军,杨成俊,唐忠诚,等.电子纤维支气管镜代替内科胸腔镜在胸腔积液中的临床应用[J].兵团医学,2013,38(4):19-21.
[2]ROBERTS M E,NEVILLE E,BERRISFORD R G.Management of a malignant pleural effusion:British Thoracic Society Pleural Disease Guideline 2010[J].Thorax,2010,65(Suppl 2):ii32-ii40.
[3]官莉,陈世雄,阮玉姝.胸腔积液279例临床分析[J].临床肺科杂志,2011,16(4):539-540.
[4]淦鑫,钟良英,陈国华,等.106例不明原因胸腔积液的内科胸腔镜诊断[J].医学研究生学报,2013,26(12):1343-1344.
[5]张培芳,罗志扬,陈钢,等.内科胸腔镜在130例老年患者不明原因胸腔积液的应用[J].中国内镜杂志,2013,19(2):213-216.
[6]WANG Z,TONG Z H,LI H J,et al.Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions:a comparative study[J].Chin Med J(Engl),2008,121(15):1384-1389.
[7]LEE P,HSU A,LO C,et al.Prospective evaluationof flexrigid pleuroscopy for indeterminate pleural effusion:accuracy,safety and outcome[J].Respirology,2007,12(6):881-886.
[8]刘志光,吴怀球,张卫东,等.电子支气管镜代替胸腔镜在不明原因胸腔积液诊断中的应用[J].中国内镜杂志,2012,18(1):85-88.
[9]林涛,林爱俊,彭桂芳.电子支气管镜代替胸腔镜在疑难胸腔积液中的诊治价值[J].中国药物与临床,2011,11(2):177-178.
[10]杨印楼,姜鲁宁.支气管镜代胸腔镜检查对原因不明性胸膜病的诊断价值[J].中国内镜杂志,2008,14(10):1056-1067.
[11]陈永倖,程宏宁,罗美娟,等.纤维支气管镜代胸腔镜在胸腔积液诊断中的应用[J].江苏医药,2010,36(18):2122-2123.
[12]杨安军,杨成俊,唐忠诚,等.电子纤维支气管镜代替内科胸腔镜在胸腔积液中的临床应用[J].兵团医学,2013,38(4):19-21.