肺结核全肺切除术后严重并发症18例分析

Analysis of 18 cases with serious postoperative complications of pneumonectomy of pulmonary tuberculosis

目的 探讨肺结核全肺切除术后并发症发生原因及防治对策。方法 对我院 6 9例肺结核全肺切除的术后发生严重并发症 18例进行回顾分析。结果 6 9例病人中术后出现呼吸功能不全 6例 ,支气管残端瘘 3例 ,术后病灶向对侧播散 2例 ,术后失血性休克 (胸腔广泛渗血所致 ) 5例 ,术后上消化道出血 2例。术后急性呼吸衰竭死亡 2例 ,胸腔内大面积渗血死亡 2例。全组术后并发症发生率 2 6 .1% (18/6 9) ,治愈好转率 94 .2 % (6 5 /6 9) ,死亡比例 5 .8% (4/6 9)。结论 全肺切除仍是治疗某些肺结核的有效手段之一 ,但应掌握好手术适应证和手术时机。结果表明 :肺结核化疗效果不满意(包括耐药因素 )、术中操作失误及术后管理不当仍是肺结核的外科治疗 。

Objective To discuss the causes of postoperative complications of pneumoectomy in pulmonary tuberculosis and drscass how to prevent to reducing the complications rate and improve the cure rate of pulmonary tuberculosis. Methods 69 cases of pneumonectomy in pulmonary tuberculosis have been reviewed including 18 cases with serious complications. Results 4 cases were died,2 died of acute respiratory failure, the rest died of diffuse bleeding in the pleural cavity;65 cases were cured including 5 bronchopleural fistula and 1 contralateral dissemiated and other complications. the complications rate is 26.1%(18/69),the mortality is 5.8%(4/69).Conclusion Pneumonectomy is still one of the effective way to treat the patients with pulmonary tuberculosis, but the operation indicationand operation opportunity should be defined; the result shows that unsatisfactory chemotherapy of pulmonary tuberculosis and wrong operative procedure and post-operation inappropriate management are still main causes to operative complications.