59例支气管结石病的外科治疗  

Surgical management of broncholithiasis

作　　者：谢冬[1] 金宇星[1] 费苛[1] 王海峰[1] 周晓[1] 陈昶[1] 朱余明[1] 姜思明[1] 段亮[1] 姜格宁[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：《中华胸心血管外科杂志》2015年第4期217-220,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结支气管结石的外科诊治经验.方法 1980年1月至2013年12月,手术治疗支气管结石病59例中男27例,女32例;平均年龄（54.1±6.2）岁.体检发现3例,余56例均因各种症状就诊.支气管结石发病部位：左侧22例,右侧37例;段支气管开口23例,叶支气管开口30例,右中间支气管2例,主支气管4例.胸部CT检查52例,均表现为支气管腔内的高密度斑块状影,并阻塞管腔,可伴有远端支气管狭窄、扩张、炎症或肺门纵隔淋巴结钙化.纤维支气管镜检查56例,未见明显异常18例,肉芽包裹样病灶12例,结石样病灶26例.择期手术55例,因大咯血急诊手术4例;行支气管切开取石3例,肺叶切除42例,支气管袖式切除3例,肺动脉成形术3例,右肺双叶切除3例,全肺切除4例,余肺切除1例.结果 全组手术顺利,无术中及术后死亡,7例发生并发症.平均手术（175.2 ±32.8）min,平均失血量为（271±103） ml,平均术后住院（8.2±3.4）天.53例平均随访22.8个月,49例术后无症状,4例症状改善.结论 胸部CT、内镜技术以及手术切除是诊断治疗支气管结石的有效措施.Objective The aim of this study was to summarize our experience in patients with broncholithiasis managed by surgical intervention.Methods From January 1980 to December 2013,59 patients were diagnosed with broncholithiasis and underwent surgical treatment in our hospital.There were 59 patients（32 females and 27 males）.Median age was （54.1±6.2） years.Fifty-six patients underwent operation for a variety of symptoms,and 3 patients for the abnormal roentgenograms.The locations of the broncholithiasis were 22 cases on the left side,and 37 cases on the right side;23 cases at the orifice of segmental bronchus,30 cases at the orifice of lobar bronchus,2 cases at the orifice of right main stem bronchus,and 4 cases at main bronchus.Thoracic computerized tomography was performed in 52 patients,which showed bronchial intraluminal high-density patches with distal bronchial stenosis,bronchiectasis,inflammation,hilar calcifications,or mediastinal lymph node calcifications.Preoperative fiberoptic bronchoscopy examination was performed in 56 cases,and was abnormal in 38 cases.Broncholiths were found in 26 patients and granulomatous lesion wrapping hard lesions in 12 patients.An elective surgical procedure was performed in 55 cases,and emergency surgery for massive hemoptysis was performed in 4 cases.Broncholithectomy without pulmonary resection was performed in 3 patients.A lobectomy was performed in 42,bilobectomy in 3,bronchial sleeve resection in 3,lobectomy with pulmonary artery plasty in 3,pneumonectomy in 4,and complete pneumonectomy in 1 patient.Results There was no operative death,and the operative complication occurred in 7 patients （11.9 %）.The average operation time was（175.2± 32.8） minutes,and the average blood loss was（271 ± 103） ml.The postoperative hospital stay was （8.2 ± 3.4） days on average.Follow-up was complete in 53 patients（89.8%） ranged from 12 to 32 months （median,22.8 months）.Forty-nine patients were asymptomatic at the time of follow-up,and 4 patients with symptomatic

关 键 词：支气管疾病 结石 外科手术 支气管镜检查 

分 类 号：R562.2[医药卫生—呼吸系统]