全胸腔镜下肺叶切除治疗继发型肺结核

Clinical study on completely thoracoscopic lobectomy in the treatment of secondary pulmonary tuberculosis

目的探讨全胸腔镜下肺叶切除治疗继发型肺结核的安全性、可行性和有效性。方法回顾性分析我院2009年9月～2013年12月完成的全胸腔镜下以肺叶切除为主的手术治疗继发型肺结核患者78例。记录中转开胸、手术时间、术中出血、术后引流液总量、带管时间、并发症和随访情况等。结果全组患者8例中转开胸,其余均在全胸腔镜下完成手术,手术平均时间（161.4±58.3）min;术中平均出血量（325.3±102.5）ml,术后平均引流液总量（1060.5±450.8）ml;术后平均带管时间（8.6±3.7）天;术后平均住院时间（10.4±3.9）天。出现术后并发症8例,其中肺漏气4例,引流液较多3例,切口延迟愈合1例。随访时间平均25.8个月,症状消失或好转,无复发、死亡患者。结论全胸腔镜下肺叶切除治疗继发型肺结核是一种安全、可行、有效的方法。

Objective To evaluate the safety,feasibility and efficacy of complete video-assisted thoracoscopic lobectomy for secondary pulmonary tuberculosis. Methods The clinical data of 78 patients with secondary pulmonary tuberculosis received complete video-assisted thoracoscopic lobectomy were analyzed. Operation time,intraoperative bleeding,postoperative drainage volume,intubation time,complications and prognosis were recorded. Results The average time of operation was（ 161. 4 ± 58. 3） min,the mean intraoperative blood loss was（ 325. 3 ± 102. 5）ml,the mean total drainage fluid after operation was（ 1060. 5 ± 450. 8） ml,the average postoperative intubation time was（ 8. 6 ± 3. 7） days,and the average postoperative hospital stay was（ 10. 4 ± 3. 9） days. Postoperative complications occurred in 8 cases,including 4 cases of pulmonary air leakage,3 cases of fluid drainage,and 1 case of delayed healing of incision. After a median follow-up of 25. 8 months,the symptoms disappeared or improved,and there was no recurrence or death occurred. Conclusion Complete video-assisted thoracoscopic lobectomy is safe feasible and effective in the treatment of patients with secondary pulmonary tuberculosis.