结核性毁损肺治疗的探讨

Treatment of tuberculous destroyed lung

目的探讨结核性毁损肺的治疗方式。方法采用临床随机对照研究对我院2008年1月～2010年12月收治的部分结核性毁损肺(符合研究条件)进行分组治疗(手术及非手术组)研究。手术组在正规抗结核2周后完善相关术前检查(结核活跃者要待结核稳定后),行毁损肺切除,本组无1例患者行胸廓成形术;非手术组一直正规抗结核治疗;两组抗结核方案均由结核内科专家组制定;对比两组治疗前后的变化。结果手术组共37例,死亡1例,并发症3例,36例患者术后随访1～3年,胸闷、气紧等症状均较术前明显好转,特别是痰菌全部阴转,咳血症状未再发,多数患者在术后3～6个月后恢复了日常生活及工作。非手术组39例一直采用内科正规抗结核,2例在治疗3个月后因咳血次数及量明显增加要求手术治疗而退出本研究,余37例患者随访1～3年,胸闷、气紧及咳血等症状无明显缓解,而且有部分患者咳血等症状较前有所加重。结论结核性毁损肺是一种不可逆的肺实质病变,需要在正规抗结核治疗基础上采用外科手术切除病肺,才能达到治愈的目的。

Objective To investigate the treatment of tuberculous lung.Methods A randomized controlled clinical study admitted to the patients,who suffering from tuberculous destroyed lung in our hospital from January 2008 to December 2010（met the study requirements）,grouping of therapy（surgery,non-surgical group） study.Improve the related preoperative examination two weeks after the regular anti-TB（If active TB,needing TB stabilized before surgery）,the surgery group had been taken the destroyed lung resection.There was no case of patients with thoracoplasty;group has been regular anti-tuberculosis treatment;Two anti-tuberculosis program non-surgical by the TB medical expert group to develop;Changes was compared in the two groups beforeand after treatment.Results There was a total of 37 cases in the operation group,1 died,3 cases with complications,36 cases were followed up for 1 to 3 years,compared with preoperative chest tightness,tight gas and other symptoms improved markedly;In particular,all turned negative sputum,hemoptysis did not relapse,the majority of patients after 3 to 6 months daily life and work（no heavy work） recovered.39 cases of non-surgical group has been using formal medical anti-tuberculosis,two casesrequired surgical treatment withdrew from the study because of the frequency and quantity of hemoptysis increased significantly after 3 months of treatment,37 patients were followed up for 1 to 3 years,the symptoms of chest tightness,tight gas and hemoptysis without significant relief,and hemoptysis symptoms in some patients than before is aggravated.Conclusion Tuberculous destroyed lung is an irreversible lung parenchymal disease.In order to achieve the purpose of healing,it needs to surgical operation excision of diseased lungs on basis of regular anti-tuberculosis treatmentd.