肺结核并发自发性气胸的治疗体会

Treatment experience of pulmonary tuberculosis complicated with spontaneous pneumothorax

目的总结肺结核并发自发性气胸的治疗经验。方法总结我科治疗的116例肺结核并发自发性气胸患者的临床资料。结果本组116例患者中,发生2次以上的复发率达8.5%,单纯胸腔闭式引流术治疗复发率21.6%;手术治疗复发率2.2%。气胸总体治愈率94.7%。结论肺结核并发自发性气胸的治疗应强调个体化;因结核病灶的存在,气胸一般通过保守治疗难以愈合,积极的外科手术疗效更确切、可靠;胸腔镜手术创伤小、术后恢复快,应作为首选;术式应以肺修补和大疱切除为主,应用自体胸膜片修补以及肺切缘加固缝合可有效预防术后肺漏气。

Objective To summarize the treatment experience of pulmonary tuberculosis complicated with spontaneous pneumothorax. Methods Clinical data of 116 in-patients with pulmonary tuberculosis complicated with spontaneous pneumothorax from June 2005 to June 2015 were retrospective analyzed. Results Of these 116 patients, the relapse rate of pneumothorax more than two times was 8.5%, the relapse rate in patients treated with closed drainage was 21.6%,the relapse rate of patients treated with operation was 2.2%. The total cure rate was 94.7%. Conclusion Individualization should be emphasized for the treatment of pulmonary tuberculosis complicated with spontaneous pneumothorax. Pneumothorax is difficult to be cured with conservative treatment only for the existence of tuberculosis focus, the therapeutic effect of active surgery is certain and reliable. VATS should be the first choice for less trauma and quick recovery. Pulmonary repair and bullectomy should be the major surgical approach. Favorable results can be achieved by using auto pleura flap and intensive suture to avoid pulmonary air leakage.