Ⅲ期结核性脓胸胸廓塌陷程度的评估及术后胸廓形态改善相关影响因素分析

doi:10.19871/j.cnki.xfcrbzz.2023.06.006

摘要/Abstract

摘要： 目的寻找Ⅲ期结核性脓胸胸廓塌陷程度的客观评价方法,分析Ⅲ期结核性脓胸术后胸廓塌陷改善的相关影响因素。方法回顾性分析2018年2月至2021年8月在成都公共卫生临床中心接受手术治疗的Ⅲ期结核性脓胸患者,于术后1、3、6、12个月分期行胸部CT检查,经隆突及剑突平面分别测量患侧及健侧骨性胸廓内缘半周长并计算“胸廓塌陷指数”,根据术后12个月随访时“胸廓塌陷改善百分比”是否≥4%,将研究人群分为胸廓塌陷显著改善组及胸廓塌陷未显著改善组。分析影响术后胸廓塌陷显著改善的因素。结果研究共纳入患者62例,其中男46例、女16例,平均年龄（27.58±12.55）岁。在隆突及剑突平面术后各随访时段胸廓塌陷指数均显著小于术前（P<0.05）,且整体呈逐渐下降趋势,至术后12个月时胸廓塌陷恢复最佳,胸廓塌陷指数最小。多因素Logistic回归分析显示：病程<6个月（P=0.048）、BMI<18.5kg/m²（P=0.043）及术前胸膜厚度<1cm（P=0.027）是经隆突平面术后胸廓塌陷显著改善的危险因素;BMI<18.5kg/m²（P=0.042）是经剑突平面术后胸廓塌陷显著改善的独立保护因素。结论通过“胸廓塌陷指数”这一指标定量评价Ⅲ期结核性脓胸的胸廓塌陷程度,初步发现了影响术后胸廓塌陷改善的影响因素。

关键词: 结核性脓胸, 胸廓塌陷, 塌陷指数, 影响因素, 相关性

Abstract: Objective To find an Objective evaluation method for the degree of thoracic collapse of stage Ⅲ tuberculous empyema, and to analyze the related factors affecting the improvement of thoracic collapse after stage Ⅲ tuberculous empyema. Method Retrospective analysis was performed on stage Ⅲ patients with tuberculous empyema who received surgical treatment in Chengdu Public Health Clinical Center from February 2018 to August 2021. Chest CT examination was performed 12 months after surgery, and the half circumference of the inner margin of the bone of the affected side and the healthy side was measured through the plane of the carina and xiphoid process, and the "thoracic collapse index" was calculated. The study population was divided into the group with significant improvement of thoracic collapse and the group without significant improvement, and the factors affecting the significant improvement of thoracic collapse were analyzed. Result A total of 62 patients were included in the study, including 46 males and 16 females, with an average age of (27.58±12.55) years. The thoracic collapse index in the carina and xiphoid plane after each follow-up period was significantly lower than that before surgery (P<0.05), and the overall trend was gradually decreasing. The thoracic collapse recovery was the best and the thoracic collapse index was the lowest 12 months after surgery. In the follow-up period of 12 months after surgery, the study population was divided into two groups: significantly improved thoracic collapse group and no significantly improved thoracic collapse group according to whether the "improvement percentage of thoracic collapse" was ≥4% or not. Multivariate logistic regression analysis showed that the disease course < 6 months (P=0.048), BMI <18.5kg/m² (P=0.043) and preoperative pleural thickness <1cm (P=0.027) were the risk factors for significant improvement of thoracic collapse after carinal plane surgery. BMI<18.5kg/m²(P=0.042) was a protective factor that significantly improved thoracic collapse after xiphoid plane surgery. Conclusion In this study, the index "thoracic collapse index" was successfully defined to quantitatively evaluate the degree of thoracic collapse in stage Ⅲ tuberculous empyema, and the related factors affecting the improvement of postoperative thoracic collapse were preliminarily found.

Key words: Tuberculous empyema, Thoracic collapse, Collapse index, Influence factor, Correlation

中图分类号:

R604

陈世铭, 李刚, 贾霜, 龚胜, 宋毅杰, 吴邦贵, 李霄, 钟明, 蒋良双, 姚晓军. Ⅲ期结核性脓胸胸廓塌陷程度的评估及术后胸廓形态改善相关影响因素分析[J]. 新发传染病电子杂志, 2023, 8(6): 31-36.

Chen Shiming, Li Gang, Jia Shuang, Gong Sheng, Song Yijie, Wu Banggui, Li Xiao, Zhong Ming, Jiang Liangshuang, Yao Xiaojun. Evaluation of the degree of thoracic collapse in stage Ⅲ tuberculous empyema and analysis of the factors related to improvement of thoracic collapse after surgery[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(6): 31-36.

参考文献

[1] 成鹏, 李军孝, 刘鑫, 等. 单操作孔胸腔镜手术联合加速康复外科理念治疗结核性脓胸的效果评价[J]. 中国防痨杂志, 2021, 43(10): 1022-1026.
[2] 李江平,吴长有. 结核性胸膜炎的固有免疫应答和适应性免疫应答的研究进展[J/CD].新发传染病电子杂志,2017, 2(3):133-137, 142.
[3] 蒋钰辉, 申磊, 戴希勇, 等. 纤维板剥脱术治疗耐药结核性脓胸的疗效分析[J]. 中华胸心血管外科杂志, 2021, 37(8): 491-495.
[4] 于大平, 韩毅, 刘志东. 外科手术治疗慢性结核性脓胸的临床疗效观察[J]. 中华医学杂志, 2014, 94(31): 2441-2443.
[5] 窦学军, 王亮, 路伟强,等. 78例结核性脓胸的外科治疗[J].中国防痨杂志, 2013, 35(9):738-740.
[6] 蒋钰辉, 刘小玉, 高超,等. 单孔胸腔镜胸膜纤维板剥脱术治疗慢性结核性脓胸[J]. 中华胸心血管外科杂志, 2022, 38(1): 18-22.
[7] 韦林, 米昌生, 吴莉. 胸腔镜在结核性脓胸纤维板剥脱术中的应用[J]. 中华胸心血管外科杂志, 2014, 30(11): 678.
[8] 周逸鸣, 洪旗, 尹桂东,等. 单孔胸腔镜全纤维板剥脱术治疗Ⅲ期结核性脓胸158例临床分析[J]. 中华外科杂志, 2022, 60(1): 90-94.
[9] 刘小玉, 徐风, 周逸鸣, 等. 单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效观察[J]. 中国防痨杂志, 2022, 44(2): 153-158.
[10] SUN W, YIN G, CAI H, et al.The efficacy and safety of uniportal video-assisted thoracic surgery on the treatment for stage II-III tuberculous empyema: a single-arm clinical retrospective study from 2016 to 2021 in a thoracic surgery center in China[J]. BMC Pulm Med, 2022, 22(1):398.
[11] KUMAR A, ASAF BB, Lingaraju VC,et al.Thoracoscopic Decortication of Stage III Tuberculous Empyema Is Effective and Safe in Selected Cases[J].Ann Thorac Surg, 2017, 104(5):1688-1694.
[12] 王庆峰, 王新康. 儿童先天性漏斗胸胸廓畸形与心电图异常的关系[J]. 天津医药, 2021, 49(8): 856-860.
[13] 纪红蕾, 王君臣, 陈诚豪, 等. 基于改进型Haller指数的儿童鸡胸自动化诊断[J]. 生物医学工程学杂志, 2018, 35(4): 571-577.
[14] 黄育斌,刘永熙,郭庆禄,等. 幼儿结核性肺脓肿CT误诊1例[J/CD].新发传染病电子杂志,2022,7(2):76-78.
[15] BAGHERI R, HAGHI SZ, DALOUEE MN, et al.Effect of decortication and pleurectomy in chronic empyema patients[J]. Asian Cardiovasc Thorac Ann, 2016, 24(3): 245-249.
[16] ZHOU Y, LI X, DAI J, et al.Uniportal Thoracoscopic Decortication for Stage III Tuberculous Empyema With Severe Rib Crowding[J]. Ann Thorac Surg, 2021, 112(1): 289-294.
[17] YAO B, LIU JY, SUN YB, et al.The Value of the Inferior Vena Cava Area Distensibility Index and its Diameter Ratio for Predicting Fluid Responsiveness in Mechanically Ventilated Patients[J]. Shock, 2019, 52(1): 37-42.
[18] KAPTEIN MJ, KAPTRIN EM.Inferior Vena Cava Collapsibility Index: Clinical Validation and Application for Assessment of Relative Intravascular Volume[J]. Adv Chronic Kidney Dis, 2021, 28(3): 218-226.
[19] 曹缘, 张梦军, 陈秋冲,等. 胃肠道手术患者全麻诱导后低血压与静脉塌陷指数的相关性研究[J]. 徐州医科大学学报, 2021, 41(2): 141-145.
[20] SERT ZS.Prognostic capacity of inferior vena cava diameter for severe postpartum hemorrhage[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 267: 6-10.
[21] REICHERT M, PÖSENTRUP B, HECKER A, et al. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients[J].Surg Endosc. 2018, 32(6):2664-2675.
[22] RUAN H, LIU F, GONG C, et al.Risk factors associated with postoperative respiratory failure in tuberculous empyema patients[J]. Medicine (Baltimore), 2021, 100(23):e25754.
[23] WU YH, WANG JL, WANG MS.Factors Associated With the Presence of Tuberculous Empyema in Children With Pleural Tuberculosis[J].Front Pediatr, 2021, 9:751386.
[24] 蒋良双, 吴邦贵, 岳冀, 等. 外科手术治疗慢性结核性脓胸的疗效分析[J].中国胸心血管外科临床杂志, 2013, 20(6):731-734.