摘要
目的探讨肺切除术在耐多药肺结核治疗中的重要性。方法回顾性分析北京胸科医院1980年1月至2007年12月行肺切除术治疗的133例耐多药肺结核患者的临床资料。手术方式包括全肺切除（45例）、肺叶切除（73例，包括支气管袖式成型5例）、胸膜全肺切除（13例）、肺段切除（1例）、楔形切除（1例），术前均进行6个月以上的抗结核治疗，术后继续抗结核治疗6～18个月。结果133例中围手术期死于呼吸衰竭的2例，内出血1例，死亡3例（2．3％）；并发症发生率为17．3％（23／133），其中支气管残端瘘9例。术后随访6个月至15年，平均52个月，用药时问为6～18个月，痰MTB阴转率为90．2％（101／112）。结论对持续痰MTB阳性，且病灶局限或痰MTB转阴、病灶局限，继续抗结核治疗3个月以上病变无好转或加重的耐多药肺结核患者，应积极采取手术治疗，肺切除术能有效提高患者的治愈率。应用吻合器缝合残端可明显降低瘘的发生率。
Objective To evaluate the clinical significance of pulmonary resection for multi-drugresistant pulmonary tuberculosis. Methods The clinical data were retrospectively reviewed for patients with multi-drug-resistant pulmonary tuberculosis for which surgical resection of the lung was undertaken. Results From January 1980 to December 2007, 1188 patients with pulmonary tuberculosis, including 133 muhi-drug resistant cases, underwent pulmonary resection in Beijing Chest Hospital. Surgical procedures included pneumonectomy in 45, pulmonary lobectomy in 73 （including sleeve resection of the bronchus in 5 ） , pleuropneumonectomy in 13, segment resection in 1, and wedge resection in 1 cases. Preoperative and postoperative antituberculosis chemotherapy was given for no less than 6 months and 6 to 18 months, respectively. Two cases died of perioperative respiratory failure, and 1 died of internal bleeding, the mortality rate being 2. 3% （ 3/133 ） . The incidence of postoperative complications was 17. 3% （23/133）, including 9 cases with stump fistula of bronchus. Follow-up lasted for 6 months to 15 years （average 52 months）, and medical treatment lasted for 6 - 18 months. After follow-up, the sputum negative conversion rate was 90.2% （101/112）. Conclusions Pulmonary resection is an effective approach to multi-drug resistant pulmonary tuberculosis with long-term sputum positivity of limited local lesions, or negative sputum of local lesions but failure to antitubereulosis chemotherapy for at least 3 months.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2009年第6期450-453,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
结核
肺
结核
抗多种药物性
肺切除术
Tuberculosis, pulmonary
Tuberculosis, multidrug-resistant
Pneumonectomy
