支气管剔除治疗支气管扩张的疗效观察

Treatment of bronchiectasis with bronchial elimination

目的探讨支气管剔除治疗支气管扩张症的合理方法和安全性。方法分析61例支气管剔除术治疗支气管扩张症患者的临床资料,术前通过支气管碘油造影或胸部螺旋CT明确诊断并确定病变部位,术中仅对有病变的肺段支气管剔除并切除有病变的肺组织,保留正常的肺组织。结果行左肺下叶切除＋舌段支气管剔除45例,右肺下叶切除＋右肺中叶支气管剔除11例（上中叶无肺裂）,左舌段切除＋前基底段剔除3例,右中叶切除＋前内基底段剔除2例。手术并发症5例,其中肺炎1例,心律失常3例,肺不张1例。无手术死亡者。60例获得随访,随访时间为6个月-16年。除1例仍有少量咳痰外,其余病例未再出现咳脓痰和咯血症状,均恢复正常工作和生活;X线检查剔除肺段肺膨胀良好。结论支气管剔除术能较好地保护肺功能,减少并发症,是治疗支气管扩张的有效方法。

Objective To evaluate the proper method and safety of treatment for bronehiectasis with bronchial elimination. Methods Clinical data of 61 patients of bronchiectasis treated with bronchial elimination was analyzed. All of diagnoses and lesion areas were identified by lipiodol bronchogram or super thin twist CT pre-operatively. Outstretched bronchi were eliminated and abnormal lung tissue was resected but normal lung tissue was saved. Results Elimination of bronchus from left lower lobe and lingual segment were 45 cases, from right lower lobe and middle lobe were 11 cases （no fissure between upper and middle lobe）, from anterior inferior basal segments of right lower lobe and middle lobe were 2 cases and from anterior basal segments of left lower lobe and lingual segment were 3 cases, respectively. Operative complication was occurred in 5 cases ： one of pneumonia, three of arrhythmia and one of pulmonary atelactasis. There was no death from operation. The follow-up rate was 98.36%（60/61）. The symptoms of purulent sputum and emptysis were disappeared and patients were back to normal lives except one patient with slight sputum. X-ray showed residual lung expanded well. Conclusions Bronchial elimination is an effective method for bronchiectasis which can save pulmonary function and reduce post operative complications.