摘要
目的探讨胸腔镜下肺切除术治疗耐药肺结核的可行性及安全性。方法回顾性分析自2010年1月至2014年1月武汉市医疗救治中心胸外科手术治疗的39例耐药肺结核患者。依据手术方式分为常规开胸肺切除术组（开胸组）24例，胸腔镜肺切除术组（胸腔镜组）15例，比较两组手术时间、术中出血量、术后疼痛评分、术后带管天数、住院天数及术后并发症等。结果39例患者均顺利完成手术。开胸组与胸腔镜组的手术时间分别为（217．8±36．7）min、（112．3±37．6）min，差异有统计学意义（t=8．65，P=0．000）；术中出血量（482．4±139．6）ml、（213．2±95．3）ml，差异有统计学意义（t=6．56，P=0．000）；术后疼痛评分分别为（7．32±1．14）分、（4．08±1．04）分，差异有统计学意义（t=6．01，P=0．000）；术后带管时间分别为（9．0±7．3）d、（8．O±4．9）d，差异无统计学意义（t=0．47，P=0．643）；住院天数分别为（14．8±5．1）d、（13．9±4．2）d，差异无统计学意义（t=0．57，P=0．571）；术后90d开胸组及胸腔镜组痰菌阴转率分别为95．8％（23／24）及100．0％（15／15），差异无统计学意义（Fisher精确概率，p=1．000）。两组患者均无支气管胸膜瘘出现。术后随访12～48个月，未见手术相关的死亡。结论胸腔镜肺切除术治疗耐药肺结核病患者安全可靠，优于常规开胸手术。
Objective To explore feasibility and safety of video-assisted thoracoscopic pneumonectomy for drug-resistant tuberculosis. Methods Thirty-nine drug-resistant tuberculosis patients with undergoing pneumo- nectomy from Wuhan Medical Treatment Center between January 2010 and January 2014 were retrospectively ana- lyzed. According to surgical procedures, the patients were divided into conventional thoracotomy surgery group （open group, n=24） and video-assisted thoracoscopie pneumoneetomy group （VATS group, n=15）. The average duration of operation, intraoperative blood loss, postoperative scores of pain, postoperative chest drainage days, time of hospitalization and the postoperative complications of the two groups were compared. Results Operations of all the 39 patients were successfully performed. The average duration of operation （（217.8 ± 36.7） min and （112.3±37.6） min; t=8.65, F=0. 000）, intra-operative blood loss （（482.4±139.6） ml and （213.2±95.3） ml; t=6.56, P=0. 000） and postoperative scores of pain between the two groups （ （7.32 ± 1.14） vs. （4.08 ± 1.04） ; t=6.01, P=0. 000） were statistically different; while the postoperative chest drainage days （9.0 ± 7.3） d vs. （8.0±4.9） d; t=0.47, P=0. 643）, the time of hospitalization （（14.8±5.1） d and （13.9±4.2） d; t=0.57, P= 0. 571） and the sputum negative conversion rate 90 days postoperative （100. 0% （15/15） vs. 95.8% （23/24） ; Fisher＇s exact test, P=1. 000） between the two groups were of no statistical difference. There was no bronchopleural fistula appears in both groups. After a following-up period of 12-48 months, no procedure-related death was observed. Conclusion Video-assisted thoracoscopic lung resection is safe and feasible for drug-resistant tuberculosis patients.
出处
《中国防痨杂志》
CAS
2017年第5期464-467,共4页
Chinese Journal of Antituberculosis
关键词
结核
肺
结核
抗多种药物性
胸腔镜
胸廓切开术
肺切除术
疗效比较研究
Tuberculosis, pulmonary
Tuberculosis, multidrug-resistant
Thoracoscopes
Thoracoto-my
Lung resection
Comparative effectiveness research
