胸腔镜辅助小切口在结核性毁损肺叶切除术中的应用  

Thoracoscope assisted small incision for lobectomy in tuberculosis patients with destroyed lung

作　　者：王成[1] 张运曾[1] 金锋[1] 

机构地区：[1]山东省胸科医院胸外科,济南250013

出　　处：《中国防痨杂志》2017年第5期445-447,共3页Chinese Journal of Antituberculosis

摘　　要：目的探讨胸腔镜辅助小切口在结核性毁损肺叶切除术中的经验及疗效。方法回顾性分析了2007年1月至2012年12月采用胸腔镜辅助小切口施行结核性毁损肺叶切除术治疗的67例患者的临床资料。其中男38例，女29例；年龄26~68岁，平均（43．0±5．3）岁；病史2～17年，平均（6．0±2．4）年。重点对患者术中情况、术后并发症处理，以及治疗转归进行总结。结果全组患者无围术期死亡，67例患者均经一次手术治愈。1例患者术后7h出现偏瘫症状，经过检查考虑为脑血管痉挛，重症加强护理病房（ICU）严密观察12h后症状逐渐消失；9例出现不同程度的心律失常，均经对症处理治愈；7例发生迁延性肺漏气，经过继续胸腔闭式引流后治愈；6例切口愈合不良，4例经过换药护理治愈，2例换药过程中发现有脓液及干酪样物质，经过敞开彻底清理后逐渐愈合。2例患者偶有血丝痰，经过胸部CT扫描及纤维支气管镜检查，均未发现异常，仍在随访中；1例行右肺上叶切除术患者，术后13个月劳累后再次出现咳嗽、咯痰症状，痰抗酸杆菌培养检测到结核分枝杆菌，胸部CT扫描显示系中叶术前稳定病灶复燃，经过调整化疗方案治疗6个月后痰菌阴转，胸部CT扫描显示中叶病变硬化、趋于稳定好转状态，目前仍在密切随访中。结论胸腔镜辅助小切口行结核性毁损肺叶切除术，在确保疗效的前提下，较好地平衡了微创、效率和安全性，在结核性毁损肺的外科治疗中是可选择的一种较为合理的手术方式。Objective To investigate experience and efficacy of thoracoscope assisted small incision for lobec- tomy in tuberculosis patients with destroy lung. Methods We analyzed retrospectively the clinical data in 67 tu- berculosis cases with destroy lung treated via thoracoscope assisted small incision for lobectomy during Jan. 2007 to Dec. 2012. There were 38 males and 29 females, average age （43.0±5.3） years old ranged from 26 to 68, average medical history （6.0±4-2.4） years ranged from 2 to 17. We focused on the summarization of intraoperative condi- tion, postoperative complications management, and treatment outcomes. Results Sixty-seven cases were cured by one time of operation without perioperative death. One case presented with hemiplegia symptom after 7 hours of op- eration due to cerebral vasospasm with symptom disappear gradually observed carefully in intensive care unit （ICU） after 12 hours. Nine cases presented with different degree arrhythmia and cured after expectant treatment. Seven ca- ses suffered from persistent pulmonary fistula and cured with closed thoracic drainage. Poor healing of incision took place in six cases and four cases were cured by dressing change. Two cases with pus and cheese like substance in in- cision were cured by thorough debridement. Two cases with bloody sputum were still followed up due to no abnormal finding in chest CT scanning. One case underwent right upper lobectomy presented with cough and expectoration symptoms. Culture was positive for Mycobacterium tuberculosis in sputum and lesion found in the middle lobe after CT scan due to recurrence from preoperative stable lesion. Chemotherapy for 6 months with adjustment regimen resulted to the sputum negative conversion and lesions sclerosis and stabilization in CT imaging. The case was still followed up at present. Conclusion Thoracoseope assisted small incision for lobectomy is one of reasonable surgi- cal procedure in tuberculosis patients with destroy lung. It balances minimally invasive, efficiency and safety

关 键 词：结核 肺 肺损伤 胸腔镜 胸外科手术 电视辅助 外科手术 微创性 回顾性研究 

分 类 号：R655.3[医药卫生—外科学]