孤立性肺结核空洞的CT表现及外科治疗分析  

Analysis of CT manifestations and surgical treatment on solitary pulmonary tuberculosis cavity

作　　者：杨继承[1] 袁跃西[1] 钱勇[1] 

机构地区：[1]长沙市中心医院胸外科,湖南长沙410004

出　　处：《中国现代医生》2013年第26期145-147,共3页China Modern Doctor

摘　　要：目的探讨孤立肺结核空洞性的CT形态学特征、外科治疗适应证及手术方法。方法收集2006年7月～2012年7月我科手术治疗的176例单纯肺结核空洞患者，根据CT分析其空洞的大小、形态、空洞壁特征及空洞周围肺组织改变情况。164例择期手术，12例大咯血急症手术。肺叶切除102例，肺段切除11例，上叶加下叶背段18例，中、下肺叶切除29例，空洞清除缝合术9例，空洞肌瓣填塞术7例。结果全组无死亡，痊愈出院。52例痰阳患者都转阴。支气管胸膜瘘2例，残腔感染3例，永久性无菌含气残腔10例，喉返神经损伤3例。2例支气管胸膜瘘，3例残腔感染经引流，加强营养支持治愈出院。术后空洞壁行病理学结构分析，分为薄壁空洞（20例）、干酪空洞（48例）和纤维空洞（108例）。CT形态上分为浸润空洞101例，纤维空洞75例。结论外科手术是空洞性肺结核内科治疗失败者较有效的手段，手术原则为宁小勿大，以肺叶切除方式为主。孤立性肺结核空洞的CT表现有助于确定手术方式及鉴别诊断。Objective To explore the CT morphologic characteristics, indications and surgical methods of surgical treatment of solitary plumonary tuberculous cavity. Methods The size, morphology, wall features and changes of sur rounding lung tissue of cavity in 176 cases with simple plumonary tuberculous cavity underwent surgery treatment in our department from July 2006 to July 2012 were analyzed according to CT. There were 164 cases with elective surgery and 12 cases with emergency operation due to massive hemoptysis. There were 102 cases with pulmonary lobectomy, 11 cases with segmentectomy, 18 cases with lobi superior and posterior segment of lower lobe lobectomy, 29 cases with middle and lower lobe lobectomy, 9 cases with cleaning cavity operation and 7 cases with cavity muscle flap packing. Results All patients recovered and discharged, and none died. 52 cases with tuberculosis in sputum showed positive turned negative. There were 2 cases with bronchopleural fistula, 3 cases with residual cavity infection, 10 cases with permanent sterile gas residual cavity, 3 cases with recurrent nerve injury. Of all 2 cases with bron chopleural fistula and 3 cases with residual cavity infection recovered and discharged by drainage and enhancing nu tritional support. There were thinwalled cavity in 20 cases, cheese cavity in 48 cases and fibrotic cavity in 108 cases according to the analysis of pathological structure of postoperative cavity wall. There were infiltrative cavity in 101 cas es, fibrotic cavity in 75 cases according to the CT morphology. Conclusion Operation is the more effective means for the patients with cavitary pulmonary tuberculosis after failure medical treatment.The operation principle is small rather than big, and mainly to pulmonay lobectomy. CT manifestations of solitary piumonary tuberculous cavity can help to confirm the operation mode and differential diagnosis.

关 键 词：肺结核 空洞 手术 CT检查 

分 类 号：R521.5[医药卫生—内科学]