摘要
目的分析耐药肺结核患者行外科手术治疗后失败的原因，以吸取经验和教训。方法回顾分析1992年10月至2014年10月在首都医科大学附属北京胸科医院内科住院和门诊接诊的17例经胸外科手术后治疗失败耐药肺结核患者，其中诊断多耐药肺结核（PDR-PTB）患者1例，耐多药肺结核（MDR-FTB）患者9例和广泛耐药肺结核（XDR-PTB）患者7例。胸外科进行病灶部位的肺叶切除15例和一侧全肺（患肺）手术切除2例。分别分析手术前和手术后耐药肺结核治疗是否规范与手术后治疗失败原因及转归。结果术前17例和术后16例均使用了2～3种“可能敏感”的抗结核药物，术后另一例虽然选择了4种敏感药，但疗程仅2个月；其中有4例MDR-PTB患者术后抗结核药物治疗失败后，更换至少4种敏感药物的有效方案治疗后治愈；8例术后反复应用不足4种敏感药的方案进行治疗而未治愈（其中PDR-PTB）例并发糖尿病，反复治疗后转为XDR-PTB；其他有MDR-PTB 3例，XDR-PTB 4例）；5例（其中MDR-PTB 2例，XDR-PTB 3例）术前和术后反复应用一线和二线抗结核药物，每次均不能组成有效的治疗方案，持续菌阳，治疗失败，和并发肺部感染和呼吸衰竭而死亡。结论耐药肺结核患者手术前和手术后选择无效方案或采用有效方案而疗程不足，会增加手术后治疗失败的风险。
Objective To analyze the causes of failure cases underwent surgical treatment in order to learn experience and lesson from these cases with drug-resistant pulmonary tuberculosis. Methods We analyzed retro- spectively 17 failure inpatients and outpatients with drug-resistant pulmonary tuberculosis underwent surgical treat- ment including 1 cases with polydrug-resistant pulmonary tuberculosis （PDR-PTB）, 9 cases with multidrug-resis- rant pulmonary tuberculosis （MDR-TB） and 7 cases with extensively dru-resistant pulmonary tuberculosis （XDR-TB） admitted in Beijing Chest Hospital. Capital Medical University during Oct. 1992 to Oct. 2014. Lobecto- my was carried out in 15 cases and one side pneumonectomy in 2 cases. We also analyzed whether the therapeutic regimen was standard before and after surgical treatment, the failure causes and the therapeutic outcomes. Results Two to three kinds probable susceptible antituberculosis drugs were given in 17 cases before surgical treatment and in 16 cases after surgical treatment. One case was given 4 kinds sensitive drugs after surgical treatment, but the duration was anly two months. Four failure cases with MDR-TB got cure after changing the regimen with 4 kinds sensitive dru^s. Eight cases were failure due to using repeatedly less than 4 kinds of sensitive drugs inclu- ding one cases complicated with diabetes developed XDR-PTB, MDR-TB in 3 cases and XDR-PTB in 4 cases. Five cases including 2 cases with MDR-PTB and 3 cases with XDT-PTB given invalid regimen with first line and second line antituberculosis drugs repeatedly were failure with sputum smear positive and death due to pulmonary infection and respiratory failure. Conclusion Patients with drug-resistant pulmonary tuberculosis receive invalid regime or valid regime but inadequate duration before and after surgical treatment will increase the risk of therapeutic failure after surgical treatment.
出处
《中国防痨杂志》
CAS
2016年第7期555-558,共4页
Chinese Journal of Antituberculosis
关键词
结核
肺/外科学
抗药性
微生物
抗药性
多药
Tuberculosis,pulmonary/surgery
Drug-resistance, microbiologist
Drug-resistance,multiple
