388例肺结核外科切除病例分析

A clinical analysis on 388 patients with pulmonary tuberculosis treated by surgical resection

目的探讨当前肺结核病的外科治疗效果和手术适应症。方法总结胸外科1999年1月—2007年12月手术切除的388例肺结核病的临床疗效。全组浸润肺结核116例,结核球或干酪性肺炎85例,慢性纤维空洞性肺结核66例,肺结核合并曲菌球形成18例,结核性支气管狭窄28例,结核性毁损肺75例。结果全肺切除术95例,肺叶切除术217例,气管或支气管成形术11例,其他手术65例。外科切除临床治愈372例治愈率95.9%,并发症33例发生率为8.5%,手术无死亡。结论虽然肺结核是以抗结核药物为主要治疗方法,但目前仍有部分患者需要外科治疗。外科手术可提高重症和耐多药肺结核的临床治愈率。

Objective To evaluate the efficacy and indication of surgical resection for pulmonary tuberculosis. Methods From January 1999 to December 2007, 388 patients with pulmonary tuberculosis hospitalized in our hospital undergone surgical resection were enrolled. There were 116 cases with infiltrative pulmonary tuberculosis,85 cases with caseous pneumonia, 66 cases with chronic fibro-cavernous pulmonary tuberculosis, 18 cases pulmonary tuberculosis complicated with aspergilloma,28 cases with tuberculous tracheobronchial stenosis, 75 cases with tuberculous destroyed lungs. Results The operative manners included： pneumonectomy in 95 cases, lobectomy in 217, tracheoplasty or bronchoplasty in 11 cases, and other manners in 65 cases. The total cure rate was 96% among 372 cases treated by operation. The rate of complication was 8.5% without dead case. Conclusions Chemotherapy is still main method to treat pulmonary tuberculosis,but the surgical operation is necessary for some patients with pulmonary tuberculosis to improve cure rate, especially for severe pulmonary tuberculosis and multidrug-resistant tuberculosis（MDR-TB）.