目的:研究电视胸腔镜(video-assisted thoracoscopic surgery,VATS)碘酊胸膜固定术治疗恶性胸腔积液的临床疗效。方法:回顾性分析47例恶性胸腔积液(malignant pleural effusion,MPE)患者的临床资料,按照疗法不同,分为碘酊硬化剂组25例,滑石粉硬化剂组22例,两组患者均为MPE确诊病例,均行胸腔镜辅助胸膜活检加胸膜固定术,具有可比性。比较两组患者术后有效率(CR+PR)、平均总引流量、不良反应发生率、胸管留置时间。结果:所有患者术后呼吸困难症状均减轻,无急性肺损伤发生。碘酊组术后有效率96.0%,滑石粉组有效率为95.5%,组间比较差异无统计学意义(P〉0.05)。术后碘酊组不良反应率32.0%;滑石粉组不良反应率63.6%。两组术后不良反应有显著性差异(P〈0.05)。结论:VATS碘酊胸膜固定术同滑石粉胸膜固定对治疗MPE有同样疗效,且较滑石粉不良反应少,治疗MPE疗效确切、操作简单、使用安全、不良反应少、价格便宜,值得临床推广应用。
Objective: To observe the therapeutic effect of video-assisted thoracoscopic surgery (VATS) with iodine tincture pleurodesis on malignant pleural effusion (MPE). Methods:Clinical data from 47 MPE cases were retrospectively analyzed. Based on different treatments, the 47 cases were divided into Groups A (n. 25) and B (n. 22), which used iodine tincture and talc powder as a hard-ener, respectively. Provided that all cases were conclusively diagnosed as MPE, and the patients underwent VATS pleural biopsy and pleurodesis, Groups A and B were comparable. The authors then compared the postoperative effectiveness rates (both complete and par-tial remissions), the volume of chest drainage, the incidence of adverse reactions, and the drainage time of the chest tube between the two groups. Results:Difficulty in breathing was proven to be less severe among all cases after the operation, and none of the patients suffered from acute lung injuries. After the operation, Group A exhibited an effectiveness rate of 96.0%, whereas Group B presented a rate of 95.5%, which indicates that no significant difference was found between the two groups (P〉0.05). The total incidence of adverse reactions was 32.0%in Group A and 63.6%in Group B, with a significant difference between the two (P〈0.05). Conclusion:VATS io-dine tincture pleurodesis has been proven to be as therapeutically effectual as talc pleurodesis and has resulted in fewer adverse reac-tions. This finding suggests that VATS iodine tincture pleurodesis has a promising potential in clinical practice because of its definite cu-rative effect, simple management, high security, fewer adverse reactions, and reasonable cost.