外科治疗非结核分枝杆菌肺病的临床疗效分析

目的探讨外科手术治疗非结核分枝杆菌(NTM)肺病的疗效及时机,为优化非结核分枝杆菌(NTM)肺病治疗方案提供循证医学依据。方法以数字表法随机选取武汉市医疗救治中心胸外科2008年10月至2014年3月确诊的NTM肺病患者85例,其中观察组42例男性28例,女性14例,年龄(36.6±1.0)岁]给予手术治疗,术后根据药敏结果用药治疗12个月以上;对照组43例男性29例,女性14例,年龄(33.4±1.5)岁],根据药敏结果用药治疗18个月以上;随访24个月,观察对比两组患者治愈率、病情无变化例数(率)、病情逆转率、死亡率,并对观察组组不同病程患者的治愈率和并发症发生率进行比较。结果对照组治愈率、死亡率分别为41.9%(18/43)、16.3%(7/43);观察组治愈率、死亡率分别为83.3%(35/42)、2.4%(1/42),观察组治愈率远高于对照组,而死亡率明显低于对照组,比较两组有统计学意义(P0.01));观察组病情逆转率分别为4.8%(2/42)亦低于对照组的18.6%(8/43),P0.05。观察组不同病程分组比较并发症及治愈率,病程3年内明显优于3-6年及6年以上(P0.01);病程3-6年优于6年以上(P0.05)。结论对确诊NTM肺病,经药物治疗6个月以上,治疗效果不理想且病变局限的患者,可考虑手术切除病肺,早期手术治疗效果优于晚期手术治疗。

Clinical effect analysis of surgical treatment for non-tuberculosis mycobacteria pulmonary disease

Objective To study the outcome and preferable timing of surgical treatment for non-tuberculosis mycobacteria ( NTM) pulmonary disease and to provide evidence-based medical evidence for optimized surgical treat-ment on NTM pulmonary disease. Methods 85 cases with NTM lung disease were selected from October, 2008 to March, 2014 in Wuhan Medical Cure Center, including the observation group 28 males and 14 females, age (36. 6 ± 1. 0)] for surgical treatment and the control group 29 males and 14 females, age (33. 4 ± 1. 5)]. According to the results of drug sensitive test, the observation group was given drug treatment more than 12 months, and the con-trol group for more than 18 months. All of them were followed-up for 24 months. Their curative rate, reversal rate and mortality were observed and compared. Results The curative rate was 41. 9% ( 18/43 ) in the control group and 83. 3% (35/42) in the observation group. The mortality was 2. 4%(1/42) in the observation group and 16. 3% (7/43) in the control group. The illness exacerbation rate was 4. 8% (2/42) in the observation group and 18. 6% in the control group (8/43). Compared with the complications and the curative rate in the observation group, their illness duration less than 3 years were significant better than that over 3 years. Conclusion For those patients with NTM lung disease received more than 6-month drug treatment without significant effect, the surgical treatment should be considered, and the curative effect is better as soon as possible.