胸腔镜、超声电导透药与胸腔穿刺治疗结核性胸膜炎的疗效及安全性比较研究

Comparative efficacy and safety of thoracoscopy, ultrasound-guided electrophonophoresis and thoracentesis in the treatment of tuberculous pleurisy

摘要

目的 本研究旨在比较胸腔镜、超声电导透药和传统胸腔穿刺3种治疗手段在结核性胸膜炎（TBP）中的疗效,并探讨超声电导透药作为胸腔镜替代方案的可能。方法 本研究为单中心回顾性队列研究,纳入2022年11月至2024年10月期间首次诊断并收治的175例结核性胸膜炎患者,按治疗方式分为胸腔穿刺组、超声电导透药组和胸腔镜组。通过比较3组患者治疗2月末胸腔积液吸收率、临床症状改善情况、并发症等临床结局,评估不同治疗手段的疗效与安全性。结果 治疗2个月末,胸腔镜组和超声电导透药组的胸腔积液减少率分别为84.0%和75.5%,均显著高于胸腔穿刺组（62.0%）。胸腔镜组和超声电导透药组在临床症状改善方面表现出相似的效果,而胸腔穿刺组效果相对较差。胸腔镜组的病理诊断阳性率为57.5%,显著高于病原学检验。治疗过程中仅胸腔镜组出现中度不良反应,发生率5.0%。结论 胸腔镜与超声电导透药对结核性胸膜炎均具有较好的疗效和安全性,尤其超声电导透药对胸腔镜禁忌或不耐受的结核性胸膜炎患者有潜在应用价值,可作为局部强化治疗的方法之一。

Abstract

Objective This study aimed to compare the efficacy of three treatment methods-thoracoscopy, ultrasound-guided electrophonophoresis (EP), and traditional thoracentesis with drainage-in patients with tuberculous pleurisy (TBP), and to investigate the potential of ultrasound-guided EP as an alternative treatment for patients who are contraindicated or intolerant to thoracoscopy. Methods This was a single-center retrospective cohort study involving 175 patients diagnosed and treated for TBP between November 2022 and October 2024. Patients were divided into three groups based on treatment: thoracentesis with drainage, ultrasound-guided EP, and thoracoscopy. The efficacy and safety of each treatment were assessed by comparing the reduction rate of pleural effusion, improvement in clinical symptoms, and incidence of complications among the groups. Results After 2 months of treatment, the pleural effusion reduction rates in the thoracoscopy (84.0%) and ultrasound-guided EP (75.5%) groups were significantly higher than in the thoracentesis group (62.0%). The clinical symptoms showed similar improvement in both the thoracoscopy and ultrasound-guided EP groups, whereas the thoracentesis group demonstrated relatively poorer results. The pathological diagnosis rate in the thoracoscopy group was 57.5%, significantly superior to that of etiological examination. No serious adverse reactions were observed in the ultrasound-guided EP group, while mild chest pain was reported in 5.0% of the thoracoscopy group. Conclusion Both thoracoscopy and ultrasound-guided EP showed good efficacy in treating TBP, with ultrasound-guided EP offering a non-invasive, safe, and feasible alternative, especially in patients with refractory pleural effusion. Ultrasound-guided EP could serve as an effective substitute for thoracoscopy in patients who are contraindicated or intolerant to the procedure.

关键词

结核性胸膜炎 / 胸腔积液 / 超声电导 / 透药 / 胸腔镜 / 胸腔穿刺

Key words

tuberculous pleurisy / pleural effusion / ultrasound-mediated / drug penetration therapy / thoracoscopy / thoracentesis

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基金资助

贵州省基础研究计划项目(黔科合基础-ZK(2022)一般673)

贵州省科技创新平台科研项目(黔科合平台CXPTXM(2025)017)

贵州省科技厅基础研究计划项目(黔科合基础(2022)一般648)