42例耐多药肺结核肺切除术治疗效果分析  

Clinical analysis of lung surgery in 42 cases with multi-drug resistant pulmonary tuberculosis

作　　者：姜友定[1] 刘志辉[1] 高健齐[1] 陈穗[1] 江涛[1] 劳燕萍[1] 

机构地区：[1]广州市胸科医院,呼吸疾病国家重点实验室(结核病研究室),广州510095

出　　处：《岭南现代临床外科》2017年第4期432-435,共4页Lingnan Modern Clinics in Surgery

基　　金：广州市医药卫生科技项目(20161A011032)

摘　　要：目的分析耐多药肺结核的手术治疗效果。方法回顾性分析我院2009年1月至2016年6月行单肺叶切除术17例、复合肺叶切除术15例、全肺切除术5例、余肺切除术3例、肺段切除术2例等共计42例耐多药肺结核肺切除术患者的临床资料和随访结果。结果 42例患者随访1~84月(26±24.8月),单肺叶切除术、肺段切除术各1例患者随访1月后丢失。40例随访资料完整的患者的治疗成功率、病情缓解率、失败率分别为80.0%(32/40)、7.5%(3/40)、12.5%(5/40,其中3例死亡),其中:单肺叶切除术分别为16/16、0、0,复合肺叶切除术分别为11/15、2/15、2/15,全肺切除术分别为3/5、1/5、1/5,余肺切除术分别为2/3、0、1/3,肺段切除术分别为1/1、0、0;手术并发症发生率35.0%(14/40),包括顽固性空腔(12.5%,5/40)、支气管胸膜瘘(12.5%,5/40),胸腔感染(5.0%,2/40),胸腔内出血(2.5%,1/40)和伤口感染(2.5%,1/40),5种手术方式的并发症发生比例分别为2/16、8/15、2/5、2/3、0。结论手术治疗有助于提高耐多药肺结核患者的治疗成功率,对于单肺叶内局限性病灶患者,建议首选单肺叶切除术;对于多肺叶切除的手术,则应积极防范手术并发症。Objective To analyze the effect of surgical treatment on the patients with multi-drugresistant pulmonary tuberculosis. Methods A retrospective analysis of the clinical data and follow-upresults were performed on a total of 42 patients with multi-drug resistant pulmonary of tuberculosis in ourhospital from January 2009 to June 2016. These 42 patients underwent different surgery procedures,included single lobectomy in 17 cases,multiple lobectomy in 15 cases,Pneumonectomy in 5 cases,completion pneumonectomy in 2 cases and segmentectomy in 2 cases. Results One patient with singlelobectomy and one patient with segmentectomy were lost after one month of follow-up. And 40 patientswere followed up for one to 84 months（26 ± 24.8 months）. For the rest 40 patients,the treatmentsuccess rate,remission rate,failure rate were 80.0%（32/40）,7.5%（3/40）,12.5%（5/40,including3 death patients）respectively. They were 16/16,0 respectively in single lobectomy patients;11/15,2/15,2/15 respectively in multiple lobectomy patients;3/5,1/5,1/5 respectively in pneumonectomypatients;2/3,0,1/3 respectively in completion pneumonectomy patients;1/1,0,0 respectively insegmentectomy patients. The incidence of complication was 35.0%（14/40）. The complications includedintractable cavity（12.5%,5/40）,bronchopleural fistula（12.5%,5/40）,pleural infection（5.0%,2/40）,pleural active bleeding（2.5%,1/40）and incision infection（2.5%,1/40）. The complicationproportions in the five surgical procedures were 2/16,8/15,2/5,2/3,0 respectively. Conclusion Surgery is helpful to improve the treatment success rate for patients with multi-drug resistant pulmonarytuberculosis. Single lobectomy should be the preferred surgical procedure for the single lobe lesions. Forthe multiple lobectomy,surgical complications should be prevented.

关 键 词：结核 肺 结核杆菌 药物耐受性 外科手术 肺切除术 叶切除术 

分 类 号：R655.3[医药卫生—外科学]