孤立性肺结核球患者胸腔镜术后化疗不同疗程效果分析

目的观察孤立性肺结核球患者胸腔镜术后化疗不同疗程的治疗效果,以选择合理疗程。方法收集2007年5月至2017年5月经电视胸腔镜行肺楔形切除术后,组织病理学确诊的孤立性肺结核球,在遵义医科大学附属医院结核病门诊继续接受抗结核化疗的患者,疗程2~12个月,连续观察24个月。分析不同化疗疗程患者的治愈率、复发率、药物不良反应发生率及服药依从率。结果共收集到术后接受抗结核化疗的孤立性肺结核球患者125例。不同化疗疗程的125例患者的治愈率均为100%,复发率均为0%。药物不良反应发生率为44.80%(25.00%~60.00%),2个月、3个月及4个月疗程患者的不良反应发生率分别为60.00%、25.00%及25.00%,3个月及4个月疗程患者的发生率最低(25.00%),发生率随疗程的延长呈上升趋势。不同疗程患者的服药依从率为62.40%(38.46%~83.33%),2个月、3个月及4个月疗程患者的服药依从率分别为80.00%、83.33%及62.50%,依从率随疗程的延长呈下降趋势,3个月疗程的依从率最高(83.33%)。三个疗程间的发生率及依从率差异均无统计学意义(P>0.05)。常见的主要药物不良反应为胃肠道反应(26.40%)、肝损伤(20.80%)及泌尿系统异常(15.63%)。61~70岁患者的发生率(59.46%)较18~40岁患者(33.33%)的高,差异有统计学意义(P<0.05)。男性患者的发生率为50.00%,较女性患者的37.25%,差异无统计学意义(P>0.05)。结论孤立性肺结核球患者胸腔镜术后3个月疗程化疗效果与其他疗程的相当,且药物不良反应发生率低,服药依从性高,3个月可作为最佳疗程;常见的主要不良反应为胃肠道反应、肝损伤及泌尿系统异常,应高度重视老年患者不良反应的发生。

Effects of different courses of chemotherapy for patients with solitary pulmonary tuberculoma after thoracoscopic resection

The effects of different courses of chemotherapy for patients with solitary pulmonary tuberculoma after thoracoscopic resection were investigated for selecting reasonable courses of chemotherapy. After video-assisted thoracoscopic lung wedge resection, the patients with solitary pulmonary tuberculoma by histopathology diagnosis were collected from May 2007 to May 2017. These patients were continually accepted tuberculosis chemotherapy for following 2～12 months in the tuberculosis clinic of our hospital. Through 24 months continuous observation, the cure rate, relapse rate, incidence rate of adverse drug reactions and medication compliance rate of the patients were analyzed in different chemotherapy courses, retrospectively. Here, a total of 125 cases with solitarypulmonary tuberculoma undergoing anti-tuberculosis chemotherapy after thoracoscopic resection were reported. Firstly, the cure rate of all 125 patients with different chemotherapy courses was 100% with no relapse (Relapse rate was 0%). Secondly, the incidence rate of adverse drug reactions was 44.80% (25.00%~60.00%). The incidence rate of adverse reactions of patients in 2, 3 and 4 months were 60.00%, 25.00% and 25.00%, respectively. The lowest incidence rate of adverse drug reactions for patients with 3 and 4 months course (25.00%) was found. The incidence rate was increased along with the prolongation of treatment course. Thirdly, the medication compliance rate was 62.40% (38.46%~83.33%). The compliance rate of patients in 2, 3 and 4 months were 80.00%, 83.33% and 62.50%, respectively. The compliance rate was decreased along with the prolongation of treatment course. Additionally, the highest compliance rate was observed in the patients with 3 months course (83.33%). There were no statistically significant differences in the incidence rate and compliance rate among three chemotherapy courses (P>0.05). The main common adverse drug reactions were gastrointestinal reactions (26.40%), anti-tuberculosis drug-induced liver injury (20.80%) and urinary system abnormality(15.63%). The incidence rates of patients aged between 18~40, 41~60 and 61~70 were 33.33%, 41.38% and 59.46%, respectively. The incidence rate(59.46%)of patients aged 61~70 was higher than that(33.33%)of patients aged 18~40. There was statistically significant difference (P<0.05). The incidence rate of male patients was 50.00% and that of female patients was 37.25%. There was no statistically significant difference (P>0.05). In conclusion, for patients with solitary pulmonary tuberculoma after thoracoscopic resection, the effect of 3-month chemotherapy course was equivalent to other chemotherapy courses, with lower incidence rate of adverse drug reactions, and higher medication compliance comparing to other chemotherapy courses. Therefore, 3-month could be the best course of chemotherapy. The main common adverse reactions are gastrointestinal reactions, liver injury and urinary system abnormalities. In elder patients, the occurrence of adverse reactions should be paid more attention.