手术联合化疗治疗耐多药肺结核结果分析

Analysis of the Outcome of Surgery Combined with Chemotherapy for Multidrug- Resistant Pulmonary Tuberculosis

目的临床上耐多药肺结核患者治疗效果往往不佳。探讨手术联合化疗治疗耐多药肺结核患者的疗效。方法对自1995年4月至2005年3月住院的48例采用外科手术治疗＋化疗的耐多药肺结核患者进行分析。肺部有空洞病变36例（75％），双侧肺均有病变16例（33．3％）。手术方式包括肺叶切除28例，全肺切除15例，胸膜全肺切除3例，肺段切除1例，楔形切除1例。结果术后死亡率2．1％（n=1）。并发症发生率16．7％（n=8）。术后随访6～90月。痰菌阴转率83．3％。结论耐多药肺结核患者若有良好的心肺功能储备，手术治疗安全有效，配合化疗能提高患者的治愈率。

Objective To discuss the feasibility of surgery combined with chemotherapy for muhidrug - resistant pulmonary tuberculosis. Method A retrospective study was performed in 48 patients with multidrug - rcsisdtant pulmonary tuberculosis treated by surgery and chemotherapy from April 1995 to March 2005. Among 36 patients（75% ） having cavitary lesions, 16 patients（33.3% ） had bilateral lesions. All patients received pulmonary resection. Operative procedures consisted of lobectomy （ n = 28 ）, pneumonectomy （ n = 15 ）, pleuropneumonectomy（ n = 3 ）, segmentectomy（ n = 1 ）, wedge resection（ n = 1 ）. Results The postoperative mortality was 2. 1% （n = 1 ）. Postoperative complications occurred in 8 patients（ 16.7% ）. The following up period lasting 6 to 90 months showed that the sputum conversion rate was 83.3%. Conclusion The surgical treatment is effective and safety providing the patients with muhidrug - resistant pulmonary tuberculosis if the patients have a good cardiopulmonary functional reserve. The treatment combined with chemotherapy can increase its cure rate.