耐多药肺结核的肺切除术

目的 分析肺切除术治疗耐多药肺结核(MDR-RTB)的效果与预后.方法 对1995年1月至2006年7月期间行肺切除术治疗的56例MDR-PFB病人进行回顾性分析.结果 病人术前痰菌均为阳性,术后阴转51例.术中无死亡,术后并发症14例.方差分析显示MDR-PTB者的肺功能与病变类型密切相关.单因素和多因素logistic回归分析均显示支气管内膜结核和吻合口包埋与术后支气管胸膜瘘(BPF)的发生率显著相关.结论 肺切除术是治疗MDR-PTB有效的辅助手段.把握MDR-PTB的手术时机可减少对肺功能的损害.支气管内膜结核是术后BPF的高危因素,而对残端吻合口包埋可有效降低术后BPF的发生率.

Clinical analysis of pulmonary resection in the treatment of multi-drug resistant pulmonary tuberculosis in 56 cases

Objective Analyze the effect and prognosis of pulmonary resection in the treatment of multi-drug resistant pulmonary tuberculosis (MDR-PTB). Methods A retrospective review was performed in 56 patients undergoing pulmonary resection for MDR-PTB between January 1995 and July 2006. Results All patients had positive sputum at the time of surgery. After the operation, the sputum remained positive in only 5 patients. There was no operative mortality. Complications occurred in 14 patients (25%). Variance analysis showed that lung function was significantly correlated with the type of lesion. Logistic regression analysis revealed that endobronchial tuberculosis and bronchial stump reinforcement were significant factors for complications fistula (BPF).Conclusion The results indicate that pulmonary resection has played an important role in the treatment of MDR-PTB. Surgical treatment of MDR-PTB in time may decrease the damage of hng function. Endobronchial tuberculosis is a risk factor for BPF but bronchial stump reinforcement can prevent BPF complications effetely.