肺结核全肺切除近期并发症的治疗  

Management of short-term complications after pneumonectomy for pulmonary tuberculosis

作　　者：洪征[1] 白连启[1] 阎东杰[1] 龚昌帆[1] 梁子坤[1] 

机构地区：[1]首都医科大学附属北京胸科医院胸外科,101149

出　　处：《中华结核和呼吸杂志》2011年第8期582-585,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨肺结核全肺切除后并发症的诊断和治疗。方法对北京胸科医院胸外科2000年9月至2010年9月经全肺切除治疗的206例肺结核患者术后近期手术并发症及其治疗效果进行回顾性分析。结果206例中发生近期手术并发症的26例，术前病变类型：毁损肺12例，肺叶切除后余肺毁损4例，结核性支气管狭窄1例，肺结核合并脓胸2例，肺结核合并支气管胸膜瘘3例（经支气管镜检查证实），空洞型肺结核2例，肺结核合并大咯血2例。26例中左肺15例，右肺11例。入院查痰为痰菌阳性7例。26例中术后14个月内急性呼吸衰竭5例，经呼吸机治疗，3例治愈，2例死亡；术后3个月ARDS2例，经呼吸机治疗，1例治愈，1例死亡；术后20d胸腔内出血7例，2例治愈，5例死亡；术后4年脓胸8例，全部治愈；术后50d支气管胸膜瘘4例，2例治愈，1例未愈，1例死亡。结论药物治疗是结核病的重要治疗方法，但部分肺结核患者仍需要外科手术治疗，全肺切除可以提高重症肺结核的治愈率，绝大多数手术并发症均可治愈。Objective To explore the diagnosis and management of short-term complications after pneumonectomy for pulmonary tuberculosis. Methods The clinical data and management of short-term complications in patients with pulmonary tuberculosis after pneumonectomy were retrospectively reviewed and analyzed. Results From September 2000 to September 2010, 206 patients with pulmonary tuberculosis underwent pneumonectomy, of whom 26 experienced complications shortly after the surgery. Postoperative acute type lI respiratory failure occurred in 5 within 14 months post-operation, acute respiratory distress syndrome （ARDS） in 2 within 3 months post-operation, chest hemorrhage in 7 within 20 days post- operation, empyema in 8 within 4 years post-operation, and bronchopleural fistula in 4 cases within 50 days post-operation. Of the 7 cases with chest hemorrhage, 2 were cured and 5 dead. All the 8 cases with empyema were cured. Of the patients with bronchopleural fistula, 2 were cured, 1 failed, and 1 was dead. Conclusions Pneumonectomy for pulmonary tuberculosis carries a higher risk of developing serious complications such as chest hemorrhage, acute type lI respiratory failure and bronchopleural fistula. Most complications can be managed successfully if diagnosed and treated early.

关 键 词：结核 肺 肺切除术 手术后并发症 治疗 

分 类 号：R655.3[医药卫生—外科学]