Objective To analyze the clinical and efficacy of treatment with different procedures of video-assisted thoracoscopic surgery (VATS) in patients with pulmonary tuberculosis.Methods We analyzed retrospectively the clinical data of treatment by VATS in 299 cases with pulmonary tuberculosis admitted in Chest Hospital of Xinjiang Uyghur Autonomous Region during Sep.2009 to Feb.2016.134 cases with pulmonary tuberculosis were conducted lobectomy,segmentectomy and pneumonectomy as group A including 111 cases poor efficacy underwent antituberculous therapy for 6 months and lesion located in one unilateral lobe,and 23 cases with massive hemoptysis and poor response underwent therapy with drugs and embolization.96 cases were conducted partial pulmonary resection as group B including 82 cases with tuberculoma (diameter ranged from 2.5 to 5 cm) poor efficacy underwent antituberculous therapy for 6 months and the other 14 cases suspected with malignant tumor.69 cases with tuberculous pleurisy were conducted pleural stripping as group C including tube drainage failed or could not be drained,and pleural thickening and encysted pleurisy showed in CT imaging.Results Of 299 cases conducted by VATS,average operation time,average intraoperative bleeding and drainage tube duration were (175.6±63.8) min,(415.9±515.7) ml and (3.2±1.5) d in Group A,respectively.There were also converted to thoracotomy in 12 cases (9.0％,12/134),and complications in 10 cases (7.5％,10/134).Average operation time,average intraoperative bleeding and drainage tube duration were (78.6±40.8) min,(62.5±107.2) ml and (3.3±1.5) d in Group B,respectively.There were also converted to thoracotomy in 2 cases (2.1％,2/96),and complications in 3 cases (3.1％,3/96).Average operation time,average intraoperative bleeding and drainage tube duration were (103.0±53.4) min,(169.5±174.2) ml and (3.0±0.8) d in Group C,respectively.There were also converted to thoracotomy in 4 cases (5.8％,4/69).Average follow up was 20 months in the three groups.In group A,there was midand long-term complication of tuberculosis dissemination occurred one month later in one case which conducted lobectomy due to massive hemoptysis and emerged with drug resistance and the lesion absorption underwent new antituberculous therapy regime according to the drug susceptibility testing.No long-term complication found in Group B and Group C.Conclusion VATS is a safe,feasible and effective technique in the treatment of patients with pulmonary tuberculosis conducted different surgical procedures according to the indication.%目的 对肺结核患者采用不同电视辅助胸腔镜手术(video assisted thoracoscopic surgery,VATS)术式的临床及疗效进行客观分析.方法 回顾分析新疆维吾尔自治区胸科医院胸外中心2009年9月至2016年2月实施VATS治疗的299例肺结核患者的临床资料.其中,134例行肺叶、肺段或全肺切除术(简称“A组”),A组患者均确诊肺结核,111例经6个月以上规范抗结核药物治疗后,效果不佳,病灶局限单侧一肺叶内,23例大咯血患者经过药物及栓塞治疗无法止血;96例行肺部分切除术(简称“B组”),B组患者中82例为术前临床影像学诊断为肺结核球患者,结核球直径＞2.5 cm、＜5 cm,经过规范药物治疗6个月以上后,疗效不佳,14例术前疑似肺部肿瘤;69例行胸膜剥脱术(简称“C组”),均诊断为结核性胸膜炎,置管引流失败或无法置管引流,胸部CT扫描提示胸膜增厚,形成包裹性胸膜炎.结果 299例实施VATS的患者中,A组手术平均时间(175.6±63.8)min,术中平均出血量(415.9±515.7) ml,中转开胸12例(9.0％,12/134),术后平均胸管留置时间(3.2±1.5)d,发生并发症10例(7.5％,10/134).B组患者手术平均时间(78.6±40.8) min,平均出血量(62.5±107.2) ml,中转开胸2例(2.1％,2/96),术后平均胸管留置时间(3.3±1.5)d,发生并发症3例(3.1％,3/96).C组患者手术平均时间(103.0±53.4) min,平均出血量(169.5±174.2) ml,中转开胸4例(5.8％,4/69),术后平均胸管留置时间(3.0±0.8)d.3组患者平均随访20个月,A组中远期并发症有1例,是大咯血患者急诊行肺叶切除术,术后1个月出现结核播散,并发现耐药感染,根据药物敏感性试验结果调整治疗2个月后病灶吸收,B组与C组无远期并发症发生.结论 对于符合上述不同手术方式适应证的肺结核患者,VATS治疗是安全、可行并且疗效肯定的选择.
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