合并强直性脊柱炎的胸膜肺部疾病23例手术临床分析

Clinical analysis on 23 cases of pleural and pulmonary diseases complicated with ankylosing spondylitis

目的探讨胸膜肺部疾病合并强直性脊柱炎手术患者的临床特点和手术效果。方法对本院自2008年8月至2015年12月共手术治疗23例胸膜肺部疾病合并强直性脊柱炎患者进行回顾性分析,其中肺叶切除术16例,肺段切除术2例,脓胸清理+纤维板剥脱术3例(其中1例加肺楔形切除术),气胸修补+胸膜摩擦固定术1例,1例因开胸后切口不能撑开,未能实施肺切除手术。结果本组患者多有不同程度肺限制性通气功能障碍。8例患者发生并发症,其中肺部感染5例,肺不张4例,呼吸衰竭4例,心力衰竭3例,支气管胸膜瘘1例,切口感染1例。其中肺不张患者实施纤维支气管镜多次吸痰,且1例无力咳痰,反复实施12次吸痰。23例均随访,22例痊愈,1例术后7个月右出现上残腔肺曲菌病,反复少量咯血,后经支气管动脉介入栓塞治疗止血,全组病例无死亡。结论胸膜肺部疾病合并强直性脊柱炎患者多有肺限制性通气功能障碍,手术难度较大,术后易发并发症,以肺炎、肺不张为主,手术效果良好,但术后需加强呼吸道管理。

Objective To investigate the clinical features and surgery efficiency of patients suffering from pleural and pulmonary diseases complicated with Ankylosing Spondylitis(AS).Methods The clinical data of 23 patients suffering from pleural and pulmonary diseases(pulmonary tuberculosis cavities,pulmonary damages caused by tuberculosis,tuberculosis bronchiectasis,chronic tuberculosis empyema,pulmonary cyst,tuberculosis complicated with pneumothorax)complicated with AS,who were admitted in authored in author complicated with AS,who were admitted June 2015 to receive surgeries,were retrospectively analyzed.Results Different degrees of pulmonary restrictive ventilation dysfunction occurred in these patients.The surgeries were performed in 22 patients,including 16 cases of pulmonary lobectomy,2 cases of pulmonary segment resection,3 cases of empyema debridement added decortication(1 of which added pulmonary wedge resection),1 case of pneumothorax repair added pleural friction fixation,and 1 case of being unable to perform the lung resection surgery due to that the incision could not open after thoracotomy.Complications occurred in 8 patients,including 5 cases of pulmonary infection,4 cases of atelectasis,4 cases of respiratory failure,3 cases of heart failure,1 case of bronchopleural fistula,and 1 case of incision infection.Among the cases of atelectasis repeatedly received aspiration of sputum by bronchoscope,there was 1 case of being unable to coughing up phlegm,who received aspiration of sputum 12 times repeatedly.For the subsequent 23 cases followed up,no death occurred,while 22 cases were cured and 1 case showed that pulmonary aspergilloma occurred in right upper residual cavity at 7 months after the operation and repeated mild hemoptysis,which was then treated by bronchial artery embolization.Conclusion Pulmonary restrictive ventilation dysfunction mostly occurred in patients suffering from pleural and pulmonary diseases complicated with AS.The surgery is difficult,and postoperative complications are easily occurred.The surgery results are good mainly in pneumonia and atelectasis,but the management of respiratory tract is needed to be strengthened subsequently.