摘要
目的探讨空洞型肺结核患者行胸腔镜手术治疗的适应证及临床效果。方法回顾性分析55例行胸腔镜手术治疗的空洞型肺结核患者的临床资料,探讨胸腔镜手术治疗空洞型肺结核患者的适应证、临床效果、术后并发症发生情况以及随访期间的复发情况。结果本组55例患者均手术顺利,其中楔形切除30例,肺段切除9例,肺叶切除16例。术后所有患者的病理报告均符合空洞型肺结核的诊断,其中6例患者肺空洞内有曲菌球寄生。术后1例患者出现血胸,给予再次开胸止血,术中探查出血部位为支气管残端周围的支气管动脉渗血;2例患者出现支气管胸膜瘘,其中1例患者行瘘修补术,另外1例患者行胸廓成形术;其余患者均恢复顺利,术后转内科抗结核治疗6～18个月。术后随访55例患者,随访时间6个月～5年,均无结核复发。结论胸腔镜手术治疗空洞型肺结核安全有效,根据结核空洞的部位、空洞与叶段支气管及肺血管的关系,采用不同的术式均为可行。
Objective To investigate the indications and clinical effects of thoracoscopic surgery for patients with cavitary pulmonary tuberculosis. Methods The clinical data of 55 patients with cavitary pulmonary tuberculosis who underwent thoracoscopic surgery were retrospectively analyzed. Discussion was made on indications, clinical effects, occurrence of complications and recurrence during follow-up period of patients with cavitary pulmonary tuberculosis treated by thoracoscopic surgery. Results All the 55 patients were operated smoothly, including wedge resection in 30 cases, segmentectomy in 9 cases and lobectomy in 16 cases. Pathological reports of all patients after operation were consistent with the diagnosis of cavitary pulmonary tuberculosis, including 6 patients with aspergillosis in the lung cavity. 1 patient developed hemothorax after operation and was treated with reoperation to stop bleeding. The bleeding site was found to be bronchial artery seepage around the bronchial stump. 2 patients had bronchopleural fistula, including 1 patient underwent fistula repair and the other 1 patient underwent thoracoplasty. The other patients recovered smoothly and were transferred to medical anti-tuberculosis treatment for 6 ~ 18 months. 55 patients were followed up for 6 months ~ 5 years. No recurrence of tuberculosis occurred. Conclusion Thoracoscopic surgery is safe and effective in the treatment of cavitary pulmonary tuberculosis. According to the location of the tuberculosis cavity and the relationship between the cavity and the lobar bronchus and pulmonary vessels, different surgical methods are feasible.
作者
林铿强
许德新
代祖建
黄法杨
LIN Keng-qiang;XU De-xin;DAI Zu-jian(Fujian Fuzhou Lung Hospital, Fuzhou 350008, China)
出处
《中国现代药物应用》
2019年第3期13-15,共3页
Chinese Journal of Modern Drug Application
关键词
空洞型肺结核
胸腔镜手术
临床效果
Cavernous pulmonary tuberculosis
Thoracoscopic surgery
Clinical effect
