肺结核合并支气管内膜结核的外科治疗

目的 总结肺结核合并支气管内膜结核的外科治疗经验.方法 分析1967年3月到2004年10月间肺结核合并支气管内膜结核患者85例,其中支气管狭窄45例,气管狭窄4例.43例行肺叶切除术,其中袖式切除8例;37例行全肺切除术,其中袖式切除4例,气管右下壁部分切除后使用右主支气管内壁组织修补术3例;3例行气管节段切除成形术;1例行左上叶支气管、肺动脉双袖式切除术;1例行开胸活检术.结果 无手术死亡病例.肺叶切除术35例(不包括袖式肺叶切除术)中,术后并发支气管胸膜瘘1例、脓胸1例;全肺切除术33例(不包括袖式全肺切除术)中,术后并发支气管胸膜瘘3例、脓胸4例;两种术式间差异有统计学意义.肺叶切除术后肺不张发生率(5/35)低于袖式肺叶切除术(3/8)(P＜0.01).随访3～10年,随访率98%;1例患者术后7年后死于急性呼吸功能衰竭.结论 肺结核合并支气管内膜结核的外科治疗应切除病变组织,根据狭窄的部位、长度、程度及狭窄远端的肺组织是否正常决定手术方式,并结合围手术期正规抗结核治疗,尽量少作全肺切除.

Surgical treatment of pulmonary tuberculosis combined with endobronchial tuberculosis

Objecfive To evaluate the experience of surgical treatment of pulmonary tuberculosis with endobronchial tuberculosis.Methods The clinical data of 85 patients with pulmonary tuberculosis and endobronchial tuberculosis undergoing surgical resection from 1967 to 2004 were reviewed retrospectively.Forty-five cases were bronchial stenosis.Four cases were tracheal stenosis.Sixteen cases underwent right upper lobectomy.One case underwent right upper and middle lobectomy.Three cases underwent right middle lobectomy.Five cases underwent right middle and lower lobectomy.Two cases underwent right lower lobectomy.Twelve cases underwent left upper lobectomy.Four cases underwent left lower lobectomy.Eight cases were assisted with sleeve lobectomy.Six cases underwent right pneumoectomy(with partial tracheal resection and tracheal reconstruction in 3 cases).Thirty cases underwent left pneumoectomy.OBe case underwent left lower lobectomy who underwent left upper lobectomy 2 years ago.Four cases were assited with sleeve pneumoectomy.Three cases underwent tracheal segment resection and tracheal reconstruction.One case underwent left upper bronchial and pulmonary artery sleeve resection.One case underwent biopsy.Results No surgical mortality occurred.There was 1 case of bronchopleural fistula and 1 case of empyema in the 35 cases(without sleeve lobectomy)who underwent lobectomy.There were 3 cases of bronchopleural fistula and 4 cases of empyema in the 33 cases(without sleeve pneumoectomy)who underwent pneumoectomy(P<0.05).There were 5 cases of atelectasis in the 35 cases who underwent lobectomy and 3 cases of atelectasis in the 8 cases who underwent sleeve lobectomy(P<0.01).In the follow-up 0f 3 to 10 years,1 case died due to acute respiratory distress syndrome 7 years postoperatively.Conclusions It is important to resect all the tissue which has been infected.With the routine anti-tuberculosis chemotherapy during the perioperative period,the effect of surgical treatment is superior to others.Fewer pneumoectomy is also important.