肺结核大咯血患者支气管动脉栓塞术后近远期行肺叶切除术的临床效果比较  

Clinical comparison of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization

作　　者：蒋钰辉 申磊 戴希勇 盛健 刘小玉 JIANG Yuhui;SHEN Lei;DAI Xiyong;SHENG Jian;LIU Xiaoyu(Department of Surgery,Wuhan Pulmonary Hospital,Wuhan Institute for Tuberculosis Control,Wuhan,430030,P.R.China)

机构地区：[1]武汉市肺科医院武汉市结核病防治所外科

出　　处：《中国胸心血管外科临床杂志》2019年第12期1190-1193,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较肺结核大咯血患者在支气管动脉栓塞术后近期和远期行肺叶切除术的围手术期指标,为临床选择合适的手术时机提供参考。方法回顾性分析2015年1月至2017年11月武汉市肺科医院外科收治的33例肺结核大咯血行支气管动脉栓塞术后行肺叶切除术住院患者的临床资料,其中男29例、女4例,年龄23~66(52.64±9.70)岁。按照行支气管动脉栓塞术与肺叶切除术之间的时间间隔将患者分为两组:<2周为近期组(14例),>1个月为远期组(19例)。观察两组手术时间、术中出血量、术后拔管时间等围手术期指标,并进行统计分析。结果近期组手术时间[(297.13±75.69)min vs.(231.32±67.57)min,P=0.013]、术中失血量[(685.74±325.51)mL vs.(355.83±259.11)mL,P=0.002]、术后拔管时间[(14.07±5.24)d vs.(8.90±3.57)d,P=0.003]均高或长于远期组,差异有统计学意义。结论对于具备手术指征的肺结核大咯血患者,急诊行支气管动脉栓塞术控制出血后,若无近期再出血风险,应尽量选择在术后远期患者身体状况恢复、原发病稳定时行肺叶切除术。Objective To compare the clinical data of pulmonary lobectomy in patients with massive hemoptysis of pulmonary tuberculosis after bronchial artery embolization in the short and long term, so as to provide a reference for clinical choices of appropriate operation time. Methods A retrospective analysis was conducted on 33 patients with massive hemoptysis of pulmonary tuberculosis, who had received pulmonary lobectomy after bronchial artery embolization in Wuhan Pulmonary Hospital from January 2015 to November 2017, including 29 males and 4 females aged of 23-66(52.64±9.70) years. According to the time interval between bronchial artery embolization and lobectomy, the patients were divided into a short-term group(<2 weeks, 14 patients) and a long-term group(>1 month, 19 patients). The clinical data, such as operation time, intraoperative blood loss, postoperative extubation time and serious postoperative complications, were observed in the two groups for statistical analysis. Results The operative time(297.13±75.69 min vs.231.32±67.57 min, P=0.013), intraoperative blood loss(685.74±325.51 mL vs. 355.83±259.11 mL, P=0.002), postoperative extubation time(14.07±5.24 d vs. 8.90±3.57 d, P=0.003) of the short-term group were all higher than those in the longterm group. Conclusion For the patients with massive hemoptysis of pulmonary tuberculosis, who had surgical indications and no risk of early rebleeding after bronchial artery embolization, pulmonary lobectomy should be performed late until the patient’s physical condition and the primary disease was stable.

关 键 词：肺结核 咯血 栓塞 肺切除术 对比研究 

分 类 号：R73[医药卫生—肿瘤]