外科手术治疗74例肺结核并发肺曲菌球病患者的临床价值  

Clinical value of surgical treatment in 74 pulmonary tuberculosis patients complicated with pulmonary aspergillosis

作　　者：廖勇 蔡青 韦鸣 许建荣 陈国强 黄喜峰 刘玮 LIAO Yon;CAI Qing;WEI Ming;XU Jian-rong;CHEN Guo-qiang;HUANG Xi-feng;LIU Wei(Department of Thoracic Surgery, Guangxi Zhuang Autonomous Region Longtan Hospital, Guangxi Zhuang Autonomous Region Chest Hospital, Guangxi Zhuang Autonomous Region Forth Hospital, Liuzhou 545005,China)

机构地区：[1]广西壮族自治区龙潭医院、广西壮族自治区胸科医院、广西壮族自治区第四人民医院胸外科,柳州545005

出　　处：《中国防痨杂志》2019年第3期260-265,共6页Chinese Journal of Antituberculosis

摘　　要：目的分析外科手术治疗肺结核并发肺曲菌球病的临床价值。方法搜集2007—2016年在广西壮族自治区龙潭医院行外科手术的74例肺结核并发肺曲菌球病患者,对手术方式、手术治疗转归、并发症、术后随访等临床资料进行回顾性分析。结果74例患者中,择期手术68例(91.9%),急诊手术6例(8.1%);73例(98.6%)手术顺利,术中因大出血死亡1例;行肺叶切除术54例(73.0%),肺段切除术5例,全肺切除术2例,复合肺切除术9例,肺楔形切除术4例。24例(32.4%)出现术后并发症:术后大出血1例,再次开胸止血治愈;呼吸功能衰竭1例,呼吸机辅助呼吸28d后成功脱机治愈;肺不张5例,4例经纤维支气管镜吸痰后肺膨胀良好,1例纤维支气管镜吸痰无效,继发呼吸功能衰竭后自动放弃治疗出院后死亡;脓胸4例,3例细菌性脓胸经持续引流治愈,1例曲霉菌性脓胸于术后15个月行电视胸腔镜脓胸廓清术时发生肺动脉破溃大出血,改为体外循环下左余肺切除术,但因不能纠正休克而死亡;肺泡胸膜瘘5例,3例经持续胸腔引流,2例行碘伏胸膜固定术加持续胸腔引流后治愈;支气管胸膜瘘1例,给予患者持续的胸腔引流3周后瘘口逐渐闭合治愈;胸部净化残腔7例,未处理。72例患者术后获得随访,1例患者随访期间死亡。最终治愈71例(96.0%),随访1~48个月,平均(11±3)个月,未见肺结核及肺曲菌球病复发。结论选择合适的患者行外科手术,治愈率高,并发症发生率及死亡率在可以接受的范围之内,绝大多数患者能治愈。Objective To analyze the clinical value of surgical treatment for pulmonary tuberculosis complicated with pulmonary aspergillosis. Methods We retrospectively analyzed the clinical data of 74 patients who were diagnosed pulmonary tuberculosis complicated with pulmonary aspergillosis and treated by lung resection in Guangxi Zhuang Autonomous Region Longtan Hospital from 2007 to 2016, including surgical methods, operative outcomes, postoperative complications and follow-up. Results Of the 74 patients, 68 (91.9%) underwent elective operation and 6 (8.1%) underwent emergency operation, 73 (98.6%) patients’ operations were successful, whereas 1 patient died of massive hemorrhage during operation. Among them, lobectomy in 54 cases (73.0%), segmentectomy in 5 cases, pneumonectomy in 2 cases, compound lung resection in 9 cases and wedge resection in 4 cases were conduced. Postoperative complications occurred in 24 cases (32.4%). One case had postoperative bleeding and was cured by thoracotomy. One case had respiratory failure and was successfully cured by ventilator assisted breath. Atelectasis occurred in 5 cases. They were treated by branchofiberoscope suction sputum therapy, of whom 4 cases achieved lung reexpansion, whereas 1 patient was ineffective and developed secondary respiratory failure (he refused further treatment and died after discharge). Empyema occurred in 4 cases. Three had bacterial empyema and were cured by continuous chest drainage. One case had aspergillus empyema, and was treated by video assisted thoracoscopic debridement 15 months after operation. However, the pulmonary artery was ruptured during operation and massive hemorrhage occurred. Then left pneumonectomy assisted by extracorporeal circulation was conducted, but the hemorrhagic shock could not been corrected and the patient died. Alveolar-pleural fistula occurred in 5 cases, of whom 3 were cured by continuous chest drainage, and 2 were cured by iodophor pleurodesis plus continuous chest drainage. Bronchopleural fistula occurred in 1 case.

关 键 词：结核 肺 肺曲菌病 共病现象 肺切除术 治疗结果 

分 类 号：R655.3[医药卫生—外科学]