胸廓造口开窗引流术在结核性脓胸伴支气管胸膜瘘中应用的疗效分析

【摘要】 目的 总结分析胸廓造口开窗引流术(OWT)在结核性脓胸伴支气管胸膜瘘中应用的治疗经验。方法 对我科在2003年至2012年56例结核性脓胸伴支气管胸膜瘘病例采用胸廓造口开窗引流术的外科治疗进行回顾性分析。本组病例胸廓造口开窗换药引流3~12个月后,分别采用Heller胸廓成形术加瘘修补术、胸膜外全肺切除术或余肺切除术、永久的开放性胸廓造口术等方法治疗。结果 全组患者有效地控制胸腔感染后,36例行Heller胸廓成形术加瘘修补术;14例胸膜外全肺切除术或余肺切除术后关闭胸廓造口,其中有5例术后出现围手术期胸腔再次感染并发症发生再次行胸廓造口术;6例患者选择永久的开放性胸廓造口开窗换药引流,无围术期死亡病例发生。结论 对结核性脓胸伴支气管胸膜瘘的患者应用胸廓造口术能有效地控制胸腔感染,降低死亡率,改善身体状况,为二期瘘修补术及消灭残腔手术创造有利条件并提高手术成功率。

Analysis of therapeutic efficacy on fenestrated drainage of thoracostomy in the treatment of tuberculous empyema associated with bronchopleural Kstula

Objective To summarize the experience of open window thoracotomy （OWT） in treating tuberculous empyema associated with bronchopleural fistula. Methods Fifty-six cases of tuberculous empyema with bronchopleural fistula were treated by open window thoracotomy. After 3-12 months of the thoracostomy drainage, the patients underwent operation as follows： Heller thoracoplasty with fistula repair, extrapleural total pneumonectomy resection, residual pneumoneetomy, permanent open thoracostomy. Results After an effective control of pleural infection, 36 cases were treated by Heller thoraeoplasty with fistula repair, 14 cases were treated by extrapleural pneumoneetomy or remaining pulmonary resection and then thoracostomies were closed, in which chest infection occurred again in 5 cases during perioperative period and underwent another thoracostomy,6 patients were treated by permanent open thoracostomy window change dressing and drainage.During the perioperative period, no death case occurred. Conclusion For the tuberculous empyema associated with bronchopleural fistula, open window thoracostomy combined with antitubereulotic therapy would effectively control pleural infection, reduce mortality, and also provide a favorable condition for repairing of fistula and eradication of residual cavity to improve the successful rate of the surgery.