“LTB-S”分类法与耐多药肺结核手术适应证探讨

The value of LTB-S classification in surgical indication for multidrug-resistant tuberculosis

目的探讨"LTB-S"分类法在耐多药肺结核手术适应证方面的价值,以减少肺结核患者的手术并发症和医疗费用。方法以中华医学会结核病学分会的《临床技术操作规范结核病分册》为依据,建立一套简单实用的"LTB-S"最佳手术时机判断系统,将耐多药肺结核外科手术患者分为Ⅰ类(绝对手术适应证)、Ⅱ类(相对手术适应证)、Ⅲ类(无手术适应证)。同时选择现有的已手术的27例肺结核手术患者进行验证分析。结果27例患者中,Ⅰ类8例,Ⅱ类17例,Ⅲ类2例,符合"LTB-S"最佳手术时机判断原则的Ⅰ类患者无并发症发生,Ⅱ类和Ⅲ类患者各出现2例手术并发症,其中Ⅲ类患者手术并发症发生率100%(2/2)。随访4个月至12年,2例Ⅲ类患者未治愈,其余患者均治愈。结论LTB-S判断系统有助于耐多药肺结核患者最佳手术适应症的判断,具有实用的临床价值,适宜在临床中推广应用。

Objective To explore the value of LTB-S classification in surgical indication for multidrug-resis- tant tuberculosis, looking for a judging system of the optimal operation time in patients with multidrug-resistant tu- berculosis to reduce the complications and medical costs. Methods We set up a simple practical LTB-S judgment system for surgery of multidrug-resistant tuberculosis based on《 Clinical technology operating specifications（tubercu- losis section） 》 written by Chinese Medical Association Tuberculosis Branch. Patients were divided into class Ⅰ , Ⅲ, which definited absolute sugery indication, relative indication and contraindication, respectively. Twenty-seven cases with pulmonary tuberculosis who has been underwent surgery were randomly chosen for this confirmatory analysis. Results Of 27 patients, 8 patients belonged to class Ⅰ , 17 class Ⅱ , and 2 class In in those who com- plied with the LTB-S class Ⅰ had no complications, the patients which complied with the LTB-S class Ⅱ and Ⅲ have much more complications which incidence were 2 patients （100G in class Ⅲ ）, respectively. Conclusion LTB-S judging system is helpful for the judgment of operative indications for multidrug-resistant tuberculosis, it is very practical on clinical and suitable for TB physicians learning and understanding.