探讨超声造影引导下细针注入尿激酶精准溶解治疗多房分隔包裹型胸腔积液的临床应用价值。

选择2021年1月至6月广州医科大学附属第一医院多房分隔包裹型胸腔积液（少-中量）患者32例，超声引导经22G细针胸腔积液内超声造影，随后经细针胸腔积液内注入小剂量尿激酶，剂量2万~3万U，留置时间30~90 min，动态观察超声造影分隔溶解及造影剂云雾状扩散情况，达到有效溶解效果节点即进行置管引流，分析对比尿激酶治疗前后影像、肺功能以及胸腔积液引流量、并发症等资料，综合判断治疗效果，采用配对t检验比较治疗前后超声参数和肺功能指标的差异。

32例患者超声造影引导下穿刺注入尿激酶溶解治疗总有效率为93.75%（30/32）。与治疗前相比，治疗后纤维素分隔积分减小［（2.39±0.66）分 vs（1.22±0.66）分］、超声造影云雾状扩散百分比增加［（26.96±12.22）% vs（75.65±16.94）%］、积液深度减小［（44.30±20.65）mm vs（18.04±12.04）mm］、范围缩小［（1906.17±905.13）mm² vs（658.91±617.82）mm²］，差异均具有统计学意义（t=6.010、-13.371、7.337、7.793，P均＜0.001），部分患者临床症状明显好转，肺功能改善：治疗后用力肺活量及第1秒用力呼气容积/用力肺活量比值均较治疗前增加［（3.11±0.94）L vs（3.05±1.01）L；（80.51±2.49）% vs（79.34±3.27）%］，差异均具有统计学意义（t=-2.377、-2.421，P=0.031、0.029）。所有患者均未出现较为严重的并发症。

超声造影能够实时动态监测胸腔内注入尿激酶后纤维素溶解情况，准确把握溶解效果节点及抽取积液的最佳时机，减少尿激酶用量和缩短尿激酶溶解时间，更具精准性、有效性和安全性。

To assess the clinical value of contrast-enhanced ultrasound (CEUS) guided urokinase injection for precise treatment of encapsulated pleural effusion.

From January to June 2021, 32 patients with capsulated pleural effusion (low to medium volume) treated at The First Affiliated Hospital of Guangzhou Medical University were included in the study. CEUS examinations were performed by injection of the contrast agent into the capsulated pleural effusion to observe the diffusion of the contrast agent. And then, 20000-30000 U of urokinase was injected into pleural effusion with a 22G fine needle, which was retained for 30-90 minutes. At the same time, CEUS examinations were performed dynamically to monitor the diffusion of the contrast agent and the dissolution of the fibrous separations in the pleural effusion, to determine the catheterization drainage occasions. The ultrasound images, pulmonary function examinations, drainage volume of pleural effusion, and complications were analyzed to make a comprehensive evaluation of the therapeutic effect. Differences in ultrasound parameters and lung function measures before and after treatment were compared using a paired t-test.

Among the 32 patients with encapsulated pleural effusion included, the overall efficiency of CEUS guided urokinase injection treatment was 93.75% (30/32). After treatment, the fibrous separation score (2.39±0.66 vs 1.22±0.66), the diffusion percentage of contrast agent [(26.96±12.22)% vs (75.65±16.94)%], the maximum depth of pleural effusion [(44.30±20.65) mm vs (18.04±12.04) mm], and the maximum range of pleural effusion [(1906.17±905.13) mm² vs 658.91±617.82) mm²] changed significantly compared with the values before treatment (t=6.010, -13.371, 7.337, and 7.793, respectively, P＜0.001 for all). In terms of pulmonary function, the changes of forced vital capacity (FVC) and the forced expiratory volume in the first second/FVC ratio after treatment were also statistically significant [(3.11±0.94) L vs (3.05±1.01) L and (80.51±2.49)% vs (79.34±3.27)%; t=-2.377 and -2.421; P=0.031 and 0.029, respectively]. No severe complications occurred in the study.

CEUS examination could be used to observe and monitor the dissolution of the fibrous separations in the pleural effusion dynamically, to evaluate the therapeutic efficiency and determine the drainage occasions, and to reduce the using of urokinase and shorten the time of treatment. CEUS guided urokinase injection represents a safe, effective, and precise method with important clinical value.