肺结核并发支气管胸膜瘘的诊治探讨

The study of diagnosis and treatment of pulmonary tuberculosis complicated with bronchial pleural fistula

目的探讨肺结核并发支气管胸膜瘘的诊断与治疗.方法采用回顾性分析法,对我院2008年1月至2015年12月期间收治的59例肺结核并发支气管胸膜瘘患者的临床资料进行分析总结.59例中,在院外因肺结核行手术治疗后出现支气管胸膜瘘16例;43例因患肺结核发生支气管胸膜瘘,包括19例结核性肺毁损并发支气管胸膜瘘（4例并发曲霉菌感染）,14例结核性脓气胸并发支气管胸膜瘘,10例结核性肺毁损伴结核性脓胸并发支气管胸膜瘘.所有患者均由结核内科专家组调整抗结核药物治疗方案,院外16例进行正规抗结核药物治疗及通畅引流,有2例进行了手术治疗;本院43例肺结核并发支气管胸膜瘘患者,均接受手术治疗.结果 院外16例患者经过保守治疗3个月后13例痊愈.未愈的3例中2例行开胸瘘口修补术,1例治愈;1例2周后再次出现支气管胸膜瘘,在术后51 d 死于全身衰竭;1例拒绝手术,于2个月后再次调整抗结核药物治疗方案后失访.43例肺结核并发支气管胸膜瘘患者给予手术治疗,术后2例在6个月自行停药,分别在术后第7、9个月支气管胸膜瘘复发,肺结核播散,经过我院结核内科专家组调整抗结核药物治疗方案及通畅引流后3个月自行愈合.59例患者中除1例失访,1例死于全身衰竭,其余57例患者均随访1-8年未再发支气管胸膜瘘,所有患者均坚持抗结核药物治疗足疗程（最长的达30个月）.并发曲霉菌感染者,术后即给予伏立康唑治疗4-8周.结论 肺结核并发支气管胸膜瘘手术治疗加术后规范化抗结核药物治疗的效果良好.

Objective To investigate the diagnosis and treatment of pulmonary tuberculosis complicated with bronchial fistula. Methods The clinical data of 59 cases of pulmonary tuberculosis complicated with bronchial pleural fistula treated in our hospital from January 2008 to December 2015 were analyzed retrospectively.In 59 cases, 16 cases were post-surgical treatment, 43 cases were tuberculosis bronchial pleural fistula,in which had 19 cases of tuberculous destroyed lung （4 cases complicated with aspergillus infection）, 14 cases of tuberculous pyopneumothorax and 10 cases of tuberculous destroyed lung with pyopneumothorax.All patients received anti-tuberculosis treatment.Drainage of pleural cavity were performed in 16 cases, operation were done in 2 cases.Forty-three cases were treated by surgical treatment in our hospital. Results Sixteen patients which received nonoperative treatment for 3 months were cured in 13 cases, repaired of fistul in 2 cases and lost to follow-up after refused surgery in 1 case.After repaired of fistul, 1 cases were cured and 1 case died of systemic failure in 51 days postoperatively.Forty-three cases of pulmonary tuberculosis complicated with bronchopleural fistula treated with surgical treatment;2 cases stopped taking the drugs in 6 months after operation and recurrence in 7 and 9 months after operation, two patients were healed in 3 months by, drainage and changing the regimen.No patients was observed recurrence in 57 patients during 1-8 years followed up.All the patients were given the anti-tuberculosis treatment （the longest up to 30 months）.The patients with aspergillosis was given voriconazole 4-8 weeks after operation. Conclusion It has shown that the effectiveness of operations combined with standardized anti-TB drug treatment are good in Pulmonary tuberculosis complicated with bronchial pleural fistula.