空洞清除术治疗复治菌阳空洞型肺结核临床研究

Cleaning cavity operation in treating relapse bacillary cavitary pulmonary tuberculosis

目的 寻找通过外科手段治疗内科无法根治的复治耐多药菌阳重症空洞型肺结核的有效途径。方法 １９８１ ～１９９８ 年６ 月采用空洞清除术治疗复治耐药空洞型肺结核１０４ 例。切除覆盖在空洞外侧的肋骨后段，游离相应部位的带蒂肋间组织，剪除空洞外侧壁，彻底清除空洞内容物，刮出新鲜创面，有机酸杀灭可能残留的结核分支杆菌，将准备好的肋间肌瓣填充于空洞残腔内，缝合固定。结果 １０４ 例中出院时治愈１０３ 例（９９０ ％ ） ，其中一次手术治愈１０１ 例（９８１ ％ ） ，好转１ 例（１０ ％ ） 。随访９８ 例中，复工率９６ ％ ，无手术死亡和复发者。结论 空洞清除术设计合理，是治疗内科无法根治的复治菌阳空洞型肺结核的有效方法。

Objective To study the effective surgical way for serious relapse multidrug resistant bacillary cavitary pulmonary tuberculosis. Methods 104 cases of serious relapse multidrug resistant bacillary cavitary pulmonary tuberculosis were cured by cleaning cavity operation from 1981 to 1998. The operation contained resecting the back rib covering the cavity, separating the intercostal tissue, cutting the external wall of the cavity, cleaning the cavity thoroughly, scraping the cavity till exposing the fresh tissue, killing the tuberculosis germs with organic acid, filling the cavity with the intercostal muscle, fixing and suturing the muscles. Results Among the 104 cases, 103 cases (99.0%) were cured, 101 cases (98.1%) were cured after the first operation, one case (1.0%) became better. Among the 98 cases follwed up, the rate of returning to work were 96%, no one died or relapsed. Conclusions The design of cleaning cavity operation is reasonable and it is the effective method to treat the relapse bacillary cavitary pulmonary tuberculosis, the rate of cure and sputum conversion are promising.