全胸腔镜下单操作孔解剖性肺段切除术治疗肺结核继发曲菌球  

Total Thoracoscopic Anatomical Segmental Pneumonectomy in the Treatment of Secondary Aspergilloma of Pulmonary Tuberculosis

作　　者：齐海亮[1] 杨阳 史雪娟 李亚斋 Qi Hailiang;Yang Yang;Shi Xuejuan(Department of Thoracic Surgery, Hebei Chest Hospital, Shijiazhuang 050041, China)

机构地区：[1]河北省胸科医院胸外科,石家庄050041

出　　处：《中国微创外科杂志》2022年第3期218-221,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河北省“三三三人才工程”资助项目(A202101066)。

摘　　要：目的探讨全胸腔镜下单操作孔解剖性肺段切除术治疗空洞型肺结核继发曲菌球的可行性。方法2015年4月~2020年7月我科采用全胸腔镜下单操作孔解剖性肺段切除术治疗空洞型肺结核继发曲菌球32例。操作孔位于腋前线第4肋或第5肋间,应用切口保护器,不使用肋骨牵开器;观察孔取腋中线第7肋或第8肋间,在全胸腔镜下行解剖性肺段切除术,遇到特殊情况中转开胸。结果3例中转开胸;余29例在全胸腔镜下完成解剖性肺段切除,其中右侧肺段19例(上叶尖后段7例,上叶后段3例,上叶尖段2例,下叶背段6例,下叶基底段1例),左侧肺段10例(上叶尖后段4例,上叶舌段1例,上叶固有段3例,下叶背段2例)。手术时间(116.6±33.8)min。术中出血量(130.4±54.4)ml。术后带管时间3~11 d,中位数5 d;术后引流液总量310~2100 ml,中位数740 ml。术后住院时间5~15 d,中位数8 d。围手术期无死亡。术后并发症2例:1例持续性漏气,1例痰中带血,对症治疗后均痊愈。术后病理均为肺结核合并曲霉菌感染。32例随访12个月,肺复张可,未发生严重并发症。结论全胸腔镜下单操作孔解剖性肺段切除治疗空洞型肺结核继发曲菌球安全、可行,效果确切,值得临床推广。Objective To investigate the feasibility of total thoracoscopic anatomical segmental pneumonectomy in the treatment of secondary aspergilloma of pulmonary tuberculosis.Methods From April 2015 to July 2020,32 patients with secondary aspergilloma of pulmonary tuberculosis treated by total thoracoscopic anatomical segmental pneumonectomy in our department were selected.Thoracoscopic single operation hole was used.The operation hole was located between the 4th or 5th rib on the axillary front.The incision protector was used instead of rib retractor.The observation hole was established between the 7th or 8th rib on the axillary midline.Anatomical segmental pneumonectomy was performed under total thoracoscopy.In case of special circumstances,conversion to thoracotomy was required.Results Among the 32 patients,conversion to thoracotomy was performed in 3 cases,and the anatomical segmental pneumonectomy under total thoracoscopy was completed in the other 29 cases.Among them,there were 19 cases of right lung segment,including 7 cases of posterior apical segment of upper lobe,3 cases of posterior segment of upper lobe,2 cases of apical segment of upper lobe,6 cases of dorsal segment of lower lobe and 1 case of basal segment of lower lobe;there were 10 cases of left lung segment,including 4 cases of posterior apical segment of upper lobe,1 case of lingual segment of upper lobe,3 cases of proper segment of upper lobe and 2 cases of dorsal segment of lower lobe.The operation time was(116.6±33.8)min.The amount of intraoperative bleeding was(130.4±54.4)ml.The postoperative tube time was 3-11 d(median,5 d).The total amount of postoperative drainage fluid was 310-2100 ml(median,740 ml).The postoperative hospital stay was 5-15 d(median,8 d).There was no death during the perioperative period.There were 2 cases of postoperative complications,including 1 case of continuous air leakage and 1 case of hemoptysis.The postoperative pathology was pulmonary tuberculosis complicated with aspergillus infection.All the patients were followed

关 键 词：胸腔镜手术 解剖性肺段切除术 肺结核 曲菌球 

分 类 号：R73[医药卫生—肿瘤]