慢性结核性脓胸461例外科治疗回顾性分析  

Operative procedure choice for surgical management of chronic tuberculous empyema： a series of461 cases

作　　者：王成[1] 金锋[1] 张运曾[1] 

机构地区：[1]山东省胸科医院胸外科,济南250013

出　　处：《中华外科杂志》2015年第8期608-611,共4页Chinese Journal of Surgery

基　　金：山东省自然科学基金资助项目（ZR2010HM045）

摘　　要：目的 探讨慢性结核性脓胸的外科治疗经验.方法 回顾性分析2006年1月至2011年12月在山东省胸科医院胸外科接受手术治疗的461例慢性结核性脓胸患者的临床资料.其中男性317例,女性144例;年龄6～79岁,平均年龄32岁.术前病程3个月至50年,其中1年以内347例,1～2年61例,2年以上53例.根据患者情况采用不同手术方法.结果 全组患者无围手术期死亡,461例中一次手术治愈445例,分期手术治愈6例.1例脓胸合并支气管胸膜瘘患者,行胸膜剥脱术＋肺叶切除术后再发支气管胸膜瘘,引流半年后行瘘修补＋肌瓣填塞术＋局限性胸廓成形术后治愈.3例切口愈合不良,经过换药治愈.5例出院后3个月内出现同侧切口附近胸壁脓肿,经过病灶清除附加局限性胸廓成形术治愈.1例胸膜全肺切除术患者于手术后1年因支气管残端瘘致余肺播散,死于呼吸功能衰竭.结论 在慢性结核性脓胸的治疗当中,手术治疗仍然有不可替代的作用,根据患者病情及身体状况选择恰当的手术方式能够取得良好的治疗效果.Objective To study the experiences and operative procedure choice for surgicalmanagement of chronic tuberculous empyema.Methods Totally 461 patients of chronic tuberculousempyema were treated surgically in Shandong Provincial Chest Hospital between January 2006 and December2011.There were 317 male and 144 female patients,aging from 6 to 79 years with a mean age of 32 years.Preoperative duration lasted from 3 months to 50 years,including 347 cases within 1 year,61 cases 1 to2 years,and 53 cases above 2 years.Chest tube drainage or pleuracentesis was performed in 395 patients,decortication in 287 patients,thoracoplasty in 13 patients,pleuropneumonectomy and resection of remaininglung in 11 patients,complex operation in 150 patients.Results There was no death perioperatively.Fourhundred and forty-five patients were cured at once,6 patients were cured by stages.One patient withempyema and bronchial fistula relapsed bronchial fistula after pulmonary lobectomy and pleural decortication,whom was cured by the combination operation which including fistula repair,muscle flap tamponing and localthoracoplasty according to the closed drainage of thoracic cavity after 6 months.Three cases were sufferedincision delayed healing and were cured by dressing change.Five cases were suffered abscess of chest wallwithin 3 months and were cured by local thoracoplasty.One patient died due to respiratory failure in one yearwhich resulted in tuberculosis spreading because of bronchial fistula after pleuropneumonectomy.Conclusions Surgical management of chronic tuberculous empyema still have irreplaceable roles.Selectingappropriate operations according to different cases will achieve good results.

关 键 词：脓胸 结核性 胸外科手术 支气管瘘 

分 类 号：R655[医药卫生—外科学]