217例空洞性肺结核的外科治疗

摘要

目的 探讨空洞性肺结核的外科治疗适应症,手术方法,术后管理.方法 自2000年1月～2009年12月,外科治疗217例空洞性肺结核,其中厚壁空洞73例,薄壁空洞34例,张力空洞26例,慢性空洞127例.痰菌阳性94例,78例均有不同程度耐药.结果 择期手术191例,大咯血急症手术26例.空洞清除18例,肺段切除27例,肺叶切除44例,上叶加下叶背段切除34例,上叶加下叶背段病灶清除21例,中下叶切除20例,中上叶切除14例,右全肺切除12例,左全肺切除23例.全组无手术死亡,6例复发,4例术后合并脓胸,4例合并支气管胸膜瘘,5例合并支气管残端瘘,其余全部病例无复发,治愈率97.1%.痰菌阴转率93.6%.讨论 外科手术是空洞性肺结核内科治疗失败者较有效的手段.手术原则为宁小勿大,以肺叶切除方式为主.%Objective To discuss the indication and methods of surgical operation in the treatment of pulmonary cavitary tuberculosis. Methods 217 operated cases of pulmonary cavitary tuberculosis have been reviewed, including 73 cases of thick-walled cavity,34 cases of thin-walled cavity, 26 cases of tensional cavity, 127 cases of Chronic cavity, 94 cases of sputum positive, 78 cases of drug rcsistance. Results 191 cases of selective surgery, 26 cases of massive hemoptysis emergency operation. 18 cases of cleaning cavity operation, 27 cases of segment resection, 44 cases of pulmonary lobectomy resection, 34 cases of the upper lobe add back segment of lower lobe resection, 21 cases of The upper lobe add back segment of lower lobe focus clea rance, 20 cases of middle-below lobe resection, 14 cases of middle-upper lobe resection, 12 cases of right pneumonectomy, 23 cases of left pneumonectomy. There were 6 cases of relapse, 4 cases merge empyema of postoperation, 4 cases merge BPF, 5 cases merge Bronchial stump fistula and the others without relapse, no dead case.The cure rate was 97.1％, and the sputum negative conversion was 93.6％. Conclusion Surgery is an effective means for patients with pulmonary tuberculosis with cavitation who had treatment failure. To extirpate the lobe of lung is the main way of operation.