Chronic thromboembolic pulmonary hypertension: clinical picture and surgical treatment.

Chronic, major vessel thromboembolic pulmonary hypertension (CTEPH), is an uncommon condition which, in the past, was an autopsy curiosity. Advances in diagnostic approaches, surgical techniques and postoperative management have transformed this disorder into a potentially curable form of pulmonary hypertension. The predominant symptom is unexplained dyspnoea on exertion. In patients with this complaint, CTEPH should be considered. Numerous pitfalls exist along the diagnostic path. Perfusion lung scans point toward the diagnosis, but often underestimate the extent of central arterial obstruction. Pulmonary angiography is the key diagnostic procedure, but the many patterns of thrombus organization-recanalization require a base of experience for proper interpretation. Criteria for selection of patients for surgery are evolving, but assurance of thrombus accessibility to surgery is critical. Surgical thromboendarterectomy bears no resemblance to acute pulmonary embolectomy. Recognition of thrombus (versus normal intima), meticulous dissection and a bloodless surgical field are essential for adequate restoration of pulmonary vascular patency. Multiple complications may arise postoperatively, and detailed attention to these is required for patient survival. With a co-ordinated, multi-specialty team effort, however, haemodynamic and clinical outcomes have been rewarding and persist long-term. Surgical mortality should steadily decline with such a co-ordinated effort, as well as earlier diagnosis and advances in surgical and postoperative management techniques.     

Atelectasis in the clinical picture of intrathoracic tuberculosis

The authors examined 85 patients with intrathoracic tuberculosis in whom the tuberculous process had been complicated by tuberculosis of the bronchi with their developed obstruction and as a result of atelectasis. Then the atelectasis-affected area became fibrotic. It was found that with the developed atelectasis, there was a persistent cession of bacterial isolation occurred, closure of decay cavities in the lung tissue, resolution of fresh focal and infiltrative changes. The presence of scarring bronchial stenosis and fibrotic atelectasis suggests of a full clinical recovery from intrathoracic tuberculosis.     

老年肺结核外科治疗的临床分析

目的　探讨老年肺结核外科治疗的临床特点。方法 对 1998-2003年进行了外科综合治疗的 56例老年肺结核的临床疗效进行回顾分析。结果 56例老年肺结核中 55例临床痊愈,治愈率98.2%；31例术前查结核菌阳性患者,术后全部阴转,痰菌阴转率 100%。结论 老年肺结核在术前合并症得到纠正,术中尽可能减少创伤,术后正确处理并发症,手术治疗老年肺结核在手术适应症许可的条件下仍是一种较好的治疗方法。     

肺结核咯血的外科治疗及疗效观察

目的 探讨肺结核合并咯血的外科治疗的适应证及手术方法.方法 回顾分析2008年10月至2012年10月在我院治疗的42例肺结核合并咯血患者的临床资料.结果 本组42例患者,行全肺切除1例,肺叶切除30例,肺楔形切除11例.术后仍有少量咯血5例,术后胸腔内出血而再次行手术治疗1例,术后肺不张、胸腔积液4例,切口感染2例,支气管胸膜瘘2例;并发症发生率为21.4％ (9/42),治愈率88.1％ (37/42).结论 外科手术是治疗肺结核大咯血和长期反复少量或中量咯血的综合治疗措施中较为有效的方法,手术原则以择期手术下肺叶切除方式为主.