耐多药肺结核133例外科治疗效果探讨

目的 探讨肺切除术在耐多药肺结核治疗中的重要性.方法 回顾性分析北京胸科医院1980年1月至2007年12月行肺切除术治疗的133例耐多药肺结核患者的临床资料.手术方式包括全肺切除(45例)、肺叶切除(73例,包括支气管袖式成型5例)、胸膜全肺切除(13例)、肺段切除(1例)、楔形切除(1例),术前均进行6个月以上的抗结核治疗,术后继续抗结核治疗6～18个月.结果 133例中围手术期死于呼吸衰竭的2例,内出血1例,死亡3例(2.3%);并发症发生率为17.3%(23/133),其中支气管残端瘘9例.术后随访6个月至15年,平均52个月,用药时间为6～18个月,痰MTB阴转率为90.2%(101/112).结论 对持续痰MTB阳性,且病灶局限或痰MTB转阴、病灶局限,继续抗结核治疗3个月以上病变无好转或加重的耐多药肺结核患者,应积极采取手术治疗,肺切除术能有效提高患者的治愈率.应用吻合器缝合残端可明显降低瘘的发生率.

Surgical treatment of 133 cases of multi-drug-resistant pulmonary tuberculosis

Objective To evaluate the clinical significance of pulmonary resection for multi-drug-resistant pulmonary tuberculosis. Methods The clinical data were retrospectively reviewed for patients with multi-drug-resistant pulmonary tuberculosis for which surgical resection of the lung was undertaken. Results From January 1980 to December 2007, 1188 patients with pulmonary tuberculosis, including 133 multi-drug resistant cases, underwent pulmonary resection in Beijing Chest Hospital. Surgical procedures included pneumonectomy in 45, pulmonary lobectomy in 73 (including sleeve resection of the bronchus in 5 ), pleuropneumonectomy in 13, segment resection in 1, and wedge resection in 1 cases. Preoperative and postoperative antituberculosis chemotherapy was given for no less than 6 months and 6 to 18 months, respectively. Two cases died of perioperative respiratory failure, and 1 died of internal bleeding, the mortality rate being 2.3% (3/133) . The incidence of postoperative complications was 17.3% (23/133), including 9 cases with stump fistula of bronchus. Follow-up lasted for 6 months to 15 years (average 52 months), and medical treatment lasted for 6 - 18 months. After follow-up, the sputum negative conversion rate was 90. 2% (101/112). Conclusions Pulmonary resection is an effective approach to multi-drug resistant pulmonary tuberculosis with long-term sputum positivity of limited local lesions, or negative sputum of local lesions but failure to antituberculosis chemotherapy for at least 3 months.