183例结核性肺病的微创手术治疗

Mini-invasive surgical therapy for 183 cases with tuberculosis pulmonary disease

目的探讨胸腔镜手术(video-assisted thoracotomy surgery,VATS)及胸腔镜辅助小切口手术(video-assisted minithoracotomy surgery,VAMTS)治疗结核性肺病的可行性和临床疗效。方法回顾性分析2010年1月至2014年12月我院胸外科利用VATS及VAMTS治疗的183例结核性肺病患者的临床资料。结果楔形切除术对肺结核病灶准确切除率达100%,痰菌阴转率为84.15%,结核复发或播散为4.37%,24(13.1%)例患者出现术后并发症,主要种类包括顽固性残腔、呼吸道感染、胸腔出血、伤口感染、持续性肺漏气、支气管胸膜瘘、胸腔感染、呼吸衰竭、气胸复发,术后随访(26.3±7.32)个月,死亡3例患者,死亡率1.6%,其余患者均治愈,未见中远期并发症,临床治愈率为98.4%。结论 VATS及VAMTS治疗结核性肺病安全可行,疗效满意。

Objective To discuss the feasibility and clinical efficacy of video-assisted thoracotomy surgery（VATS） and video-assisted minithoracotomy surgery（VAMTS） for the surgery treatment of tuberculous pulmonary disease. Methods The clinical data of 183 cases with tuberculous pulmonary disease patients treated by VATS and VAMTS were analyzed retrospectively in our hospital thoracic surgery from January 2010 to December 2010. Results The accurate removal rate of wedge resection was 100%, the negative conversion rate of sputum smear was 84.84%, the rate of tuberculosis recurrence and spread was 4.37%. A total of 24 （13.1%） patients developed postoperative complications, the main types include refractory residual cavity, respiratory infections, chest cavity bleeding, wound infection, persistent pulmonary air leak, bronchial pleural fistula, chest cavity infection, respiratory failure, pneumothorax recurrence. Postoperative follow-up （26.3 _＋ 7.32） months, 3 patients died, the mortality rate was 1.6%, and the rest of patients were cured, no long-term complications, clinical cure rate was 98.4%. Conclusions VATS and VAMTS in the treatment of tuberculosis pulmonary tuberculosis is safe and feasible, the curative effect is satisfactory.