胸膜内胸廓成型术治疗肺结核术后脓胸78例的效果分析  

The effect of intrapleural thoracoplasty in the treatment of postoperative empyema with pulmonary tuberculosis (the experiences of the past 3 decades)

作　　者：杨健[1] 姜格宁[1] 童稳圃[1] 汪浩[1] 

机构地区：[1]同济大学附属上海市肺科医院胸外科,200433

出　　处：《临床肺科杂志》2008年第6期732-733,共2页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨胸膜内胸廓成型术治疗肺结核术后脓胸的效果。方法1975～2005年间,共78例肺结核术后脓胸病例,其中男性71例,女性7例,年龄17～82岁,平均为43.81岁。4例合并支气管胸膜瘘。右侧48例,左侧30例,所有病例均行胸膜内胸廓成型术、肌瓣填充术,有8例同期做大网膜填充术。术后加压包扎、全身抗痨治疗、营养支持和常规抗生素治疗。结果:有1例术后发生脓胸心源性休克而死亡,2例呼吸功能不全而使用呼吸机支持过渡,1例并发食道瘘,57例术后并发脓胸(和瘘管),需长期换药。Ⅰ期治愈17例,占21.79%,在1975～1985年间有43例肺结核术后脓胸病人接受了胸膜内胸廓成型术,Ⅰ期治疗成功率为27.91%,在1986～1995年间,有26例肺结核术后脓胸病人接受了胸膜内胸廓成型术,Ⅰ期治疗成功率为19.23%,而在1996～2005年间,9例病人接受了胸膜内胸廓成型术,Ⅰ期治疗成功率为0。结论加强围术期的准备和手术技巧,加强年轻一代普胸外科医师对该手术方式的掌握可最大限度地使病人从中受益。Objective To study the effect of intrapleural thoracoplasty in the treatment of postoopecative empyema with pulmonary tuberculosis. Method During the years of 1975 and 2005 inclusive, 78 cases of postoperative empyema with pulmonary tuberculosis were treated by thoracoplasty. Results During the years of 1975 and 1985, the successful rate in Stage I was 27.91% （ n =43）. Conclusion The pulmonary tuberculosis is a disease in wholeness and the surgical treatment is one of the treating methods. It is critical to use anti- TB medication before and after the surgery. The patients will get more benefits from the intrapleural thoracoplasty by strengthening the practice of young general thoracic surgeons, increasing surgical skills and perioperative care skills.

关 键 词：胸膜内胸廓成型术 肺结核 术后脓胸 临床分析 

分 类 号：R655[医药卫生—外科学]