肺结核病患者全肺切除的临床疗效分析

目的 探讨全肺切除治疗肺结核病的临床效果和手术适应证.方法 总结北京胸科医院胸外科1992年1月至2008年12月全肺切除的174例肺结核病患者的临床疗效.全组包括结核性毁损肺106例、慢性纤维空洞性肺结核27例、肺结核性空洞合并曲菌球5例、结核性支气管狭窄16例、支气管胸膜瘘5例、肺结核合并脓胸4例、大咯血11例.结果 全肺切除术146例、胸膜全肺切除21例、余肺切除3例、全肺切除+胸廓成形术1例、全肺切除+气管成形3例.全组临床治愈率93.0%,手术并发症率为11.5%,手术病死率为2.3%.半年内与手术有关的死亡3例.结论 虽然临床上肺结核病的主要治疗方法是抗结核药物治疗,仍有部分患者需要外科手术治疗.全肺切除术可提高重症和耐多药肺结核的临床治愈率.

Clinical analysis of treating 174 cases with pulmonary tuberculosis by pneumonectomy

Objective To evaluate the efficacy and indication of pneumonectomy in patients with pulmonary tuberculosis. Methods From January 1992 to the end of 2008, 174 patients with pulmonary tuberculosis underwent pneumonectomy. According to the classification of pulmonary tuberculosis, there were tuberculous destroyed lungs ( n = 106 ), chronic fibro-cavernous pulmonary tuberculosis ( n = 27 ), cavernous pulmonary tuberculosis with aspergilloma ( n = 5 ), tuberculous tracheobronchial stenosis (n =16),pulmonary tuberculosis with encapsulated empyema (n = 5), tuberculous empyema with broncho pleural fistula ( n = 4) and massive hemoptysis (n = 11). Results The surgical approaches were pneumonectomy (n = 146 ), pleuropneumonectomy ( n = 21 ), chlorine pneumonectomy ( n = 3 ), pneumonectomy with thoracoplasty (n = 1 ) and pneumonectomy with tracheoplasty ( n = 3). The overall clinical cure rate was 93.0%, the rate of complications 11.5% and the operative mortality 2. 3%. There were 3 dead cases resulting from operations in six months. Conclusion Tuberculosis chemotherapy is an important modality for pulmonary tuberculosis, but surgical therapy remains essential for some patients. Pneumonectomy may increase the cure rates of severe pulmonary and multiple drug resistant tuberculosis.