结核性脓胸并发支气管胸膜瘘的外科治疗策略  

Surgical management of patients with tuberculous empyema accompanying bronchopleural fistula

作　　者：王成[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9期931-934,共4页Chinese Journal of Antituberculosis

基　　金：山东省自然科学基金（ZR2010HM045）

摘　　要：目的探讨结核性脓胸并发支气管胸膜瘘患者的外科治疗经验.方法 回顾性分析2001年1月至2015年12月接受手术治疗的连续147例结核性脓胸并发支气管胸膜瘘患者的临床资料.其中男83例,女64例;年龄6-77岁,平均（54.0±4.6）岁.根据患者情况采用不同手术方式：行胸腔闭式引流术147例,其中对已经行胸腔闭式引流但效果不好的患者行脓胸病灶廓清术加胸腔闭式引流术33例;行胸膜纤维板剥脱术及瘘修补术57例;行胸膜肺切除术29例;行胸廓成形术 26例;胸壁带蒂肌瓣填充联合局限性胸廓成形术9例.对并发胸壁窦道者一并行窦道切除术.结果 全组患者无围术期死亡.147例患者中经过引流治愈5例,一次手术治愈107例,复发14例,好转21例.术后7例发生迁延性肺漏气,9例患者切口愈合不良.结论 在结核性脓胸并发支气管胸膜瘘患者的治疗过程中,手术治疗仍然有不可替代的作用,根据病变的部位、范围,以及患者的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 explore the experience of surgical treatment in patients with chronic tuberculous empyema accompanying bronchopleural fistula. Methods The clinical information and data of 147 patients with tuberculous empyema accompanying bronchopleural fistula, who received surgical treatment in our hospital from January 2001 to December 2015, were retrospectively reviewed and analyzed.Among those patients, 83 were male while 64 were female;age was ranged from 6 years to 77 years and the average age was （54.0±4.6） years.The different surgical techniques were given to different patients according to their situation： 147 patients received thoracic closed drainage;33 patients, who were not effective with the treatment of thoracic closed drainage, received surgical resection of empyema plus closed thoracic drainage;decortication combined with fistula repair was performed in 57 patients;pleuropneumonectomy or resection of remaining lung were performed in 29 patients;thoracoplasty was performed in 26 patients;thoracoplasty with muscle pedicle flap transposition was performed in 9 patients. Results There was no perioperative death in the whole group.Among 147 patients, 5 patients were cured by chest tube drainage, 107 patients were cured by operation at once, 14 patients relapsed, 21 patients improved.Pulmonary air leak happened in 7 cases and 9 cases suffered incision delayed healing and were cured by dressing change. ConclusionSurgical management still plays an irreplaceable role in treatment of the patients with tuberculous empyema accompanying bronchopleural fistula.The appropriate surgical methods, which are selected according to the location and degree of the lesions as well as the general conditions of the patients, can achieve good treatment outcomes.

关 键 词：脓胸 结核性 支气管瘘 胸膜疾病 胸外科手术 治疗结果 

分 类 号：R655.3[医药卫生—外科学]