胸腔镜下病灶清除术治疗纵隔淋巴结结核  

Thoracoscopic focal cleaning treatment for mediastinal lymph node tuberculosis

作　　者：汤中文[1] 倪正义 

机构地区：[1]武汉市医疗救治中心胸外科,湖北武汉430023

出　　处：《临床肺科杂志》2017年第10期1889-1892,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析胸腔镜下病灶清除术治疗纵隔淋巴结结核的价值及经验教训,总结临床经验。方法对武汉市医疗救治中心2009年8月至2014年9月间采取胸腔镜下病灶清除术治疗的31例纵隔淋巴结结核患者进行回顾性分析,观察手术方式、并发症及复发率,总结手术治疗的时机、技巧以及治疗效果。结果31例患者均完成了手术,全胸腔镜下完成27例(27/31,87.1%),辅助小切口3例(3/31,9.7%),中转开胸1例(1/31,3.2%);术中完整淋巴结切除4例(4/31,12.9%),包膜内病灶清除24例(24/31,77.4%),病灶残留3例(3/31,9.7%);术中血管损伤2例(2/31,6.5%),肺组织损伤并肺泡漏5例(5/31,16.1%),喉返神经损伤1例(1/31,3.2%),术后未出现结核性脓胸,无死亡病例;随访2年,复发1例,余均治愈。结论胸腔镜下病灶清除术治疗纵隔淋巴结结核安全有效,但应个体化分析患者情况,采取适当的手术方式及技巧以减少并发症,提高治疗效果。Objective To analyze the value and experience of thoracoscopic focal cleaning treatment for pa-tients with mediastinal lymph node tuberculosis and summarize clinical experience. Methods 31 patients with medi-astinal lymph node tuberculosis underwent thoracoscopic focal cleaning treatment from August 2009 to September 2014 in Wuhan Medical Treatment Center were reviewed retrospectively. The operative methods, complications and recur-rence rate were reviewed, and the timing, technique of surgical treatment and the therapeutic effect were summarized. Results Of 31 patients, 27 underwent complete thoracoscopic surgery （27/31, 87. 1% ） , 3 cases （3/31, 9.1%） assisted with small incision, and 1 case with thoracotomy （1/31）. There were 4 cases of complete lymph node dis-section （4/31, 12. 9% ） , 24 cases of capsule lesions removed （2 4 /3 1 , 77. 4% ） and 3 cases of residual lesions （ 3 / 31,9. 1% ） . Vascular injury were in 2 cases （ 6. 5% ） , lung injury and alveolus leakage in 5 cases （16. 1 % ） , and recurrent laryngeal nerve injury in 1 case （ 3. 2% ）. There was no tuberculosis empyema and death reported, during 2 years follow-up, all were cured except 1 recurrent case. Conclusion Thoracoscopic focal cleaning treatment is effec-tive and safe in treatment of mediastinal lymph node tuberculosis. However, it is necessary to analyze the patients^ condition and take appropriate surgical methods and techniques to reduce the complication and improve the therapeu-tic effect.

关 键 词：纵隔 淋巴结结核 胸腔镜手术 病灶清除术 

分 类 号：R655.5[医药卫生—外科学]