“LTB-S”分类法与耐多药肺结核手术适应证探讨

目的 探讨“LTB-S”分类法在耐多药肺结核手术适应证方面的价值，以减少肺结核患者的手术并发症和医疗费用。 方法 以中华医学会结核病学分会的《临床技术操作规范结核病分册》为依据，建立一套简单实用的“LTB-S”最佳手术时机判断系统，将耐多药肺结核外科手术患者分为Ⅰ类（绝对手术适应证）、Ⅱ类（相对手术适应证）、Ⅲ类（无手术适应证）。同时选择现有的已手术的27例肺结核手术患者进行验证分析。 结果 27例患者中，Ⅰ类8例，Ⅱ类17例，Ⅲ类2例，符合“LTB-S”最佳手术时机判断原则的Ⅰ类患者无并发症发生，Ⅱ类和Ⅲ类患者各出现2例手术并发症，其中Ⅲ类患者手术并发症发生率100%（2/2）。随访4个月至12年，2例Ⅲ类患者未治愈，其余患者均治愈。 结论 LTB-S判断系统有助于耐多药肺结核患者最佳手术适应症的判断，具有实用的临床价值，适宜在临床中推广应用。

The value of LTB-S classification in surgical indication for multidrug-resistant tuberculosis

Objective To explore the value of LTB-S classification in surgical indication for multidrug-resis-tant tuberculosis,looking for a judging system of the optimal operation time in patients with multidrug-resistant tuberculosis to reduce the complications and medical costs.Methods We set up a simple practical LTB-S judgment system for surgery of multidrug-resistant tuberculosis based on《Clinical technology operating specifications(tuberculosis section)》 written by Chinese Medical Association Tuberculosis Branch.Patients were divided into class Ⅰ,Ⅱ,Ⅲ which definited absolute sugery indication,relative indication and contraindication,respectively.Twenty-seven cases with pulmonary tuberculosis who has been underwent surgery were randomly chosen for this confirmatory analysis.Results Of 27 patients,8 patients belonged to class Ⅰ,17 class Ⅱ,and 2 class Ⅲ in those who complied with the LTB-S class Ⅰ had no complications,the patients which complied with the LTB-S class Ⅱ and Ⅲ have much more complications which incidence were 2 patients(100% in class Ⅲ),respectively.Conclusion LTB-S judging system is helpful for the judgment of operative indications for multidrug-resistant tuberculosis,it is very practical on clinical and suitable for TB physicians learning and understanding.