205例肺结核合并支气管结核的外科治疗回顾分析

目的探讨肺结核合并支气管结核的外科治疗效果和手术适应症。方法总结1973年1月至2007年底手术切除的205例肺结核合并支气管结核的临床疗效。全组肺结核包括：原发综合征3例、浸润性肺结核19例、空洞性肺结核53例、慢性纤维空洞性肺结核45例、结核瘤或干酪性肺炎48例、结核性支气管狭窄27例、毁损肺10例。按照支气管结核分型，I型30例、Ⅱ型91例、川型50例、IV型34例。结果全肺切除术15例、全肺切除+胸廓成形术（胸改术）32例、肺叶切除术106例、肺叶切除术+胸改29例、支气管袖状成形术14例，其他手术9例。全组临床治愈率93.0%，手术并发症率为11.2%，手术死亡率为0.05%。结论虽然肺结核合并支气管结核是以抗结核药物为主要治疗方法，但目前仍有部分患者需要外科治疗。手术可提高肺结核合并支气管结核的临床治愈率。

Analysis on Surgical Treatment in 205 Patients with Pulmonary Tuberculosis Combined with Bronchial Tuberculosis

Objective To investigate the effect and indications of surgical resection in pulmona- ry tuberculosis combined with bronchial tuberculosis. Methods From January 1973 to December 2007, 205 patients with pulmonary tuberculosis combined with bronchial tuberculosis underwent surgical resection therapy. According to classification of pulmonary tuberculosis,there were 3 cases of primary pulmonary tuberculosis, 19 infiltrative pulmonary tuberculosis, 53 cavitary pulmonary tuberculosis, 45 chronic fibro-cavernous pulmonary tuberculosis, 48 tuberculosis tumor or caseous pneumonia,27 tuberculous tracheobronchial stenosis, 10 destroyed lungs. According to Chinese classification of bronchial tuberculosis, there were 30 cases of type I, 91 type Ⅱ ,50 type Ⅲ,34 type Ⅳ. Result The modes of surgical treatment included, pneumonectomy in 15 cases, pneumonec- tomy combined with thoracoplasty in 32 cases, lobectomy in 106 cases, lobectomy combined with thoracoplasty in 29 cases, lobectomy or pneumonectomy combined with bronchoplasty in 14 cases, Other operations in 9 cases. The overall clinical cure rate was 95.0~. The rate of complication was 11.2~. The operation mortality was 0.05%. Conclusion Although chemotherapy is an impor- tant treatment for pulmonary tuberculosis combined with bronchial tuberculosis, the operation is necessary for part of the patients. Surgical operations may increase cure rates of the patients.