胸腔冲洗在结核性支气管胸膜瘘术前治疗中的价值(附68例报告)

Retrospective analysis on value of thoracic irrigation in preoperative preparation for tuberculous bronchopleural fistula treatment

回顾性分析2010年1月至2016年12月河北省胸科医院胸外科收治的68例结核性支气管胸膜瘘患者的临床资料。68例患者均给予规律有效的抗结核药物治疗12~18个月,术前均通过胸腔冲洗(根据细菌培养情况给予生理盐水+异烟肼,或生理盐水+左氧氟沙星,或生理盐水+醋酸氯已定)治疗3~12个月,后经单纯胸腔冲洗、胸膜纤维板剥脱术、支气管胸膜瘘修补术、胸廓成形术等方法治疗。结果显示,68例患者经单纯胸腔冲洗瘘口闭合未行手术治疗治愈者7例;行胸膜纤维板剥脱及瘘口修补术治愈20例;行胸廓成形及瘘口修补术治愈38例;长期带管生存3例。对结核性支气管胸膜瘘患者术前应用胸腔冲洗可有效控制胸腔感染,为后期手术创造有利条件。

A retrospective study was conducted by analyzing the clinical information and data collected from 68 patients with tuberculous bronchopleural fistula who were admitted to the Chest Surgery Department of Hebei Chest Hospital from January 2010 to December 2016. Each patient received regular and effective anti-tuberculosis treatment for 12-18 months. Before operation, each patient also received thoracic irrigation (based on the bacterial culture results to provide saline+isoniazid or saline+levofloxacin or saline+chlorhexidine acetate) for 3-12 months, and then the patients received the operations as follows for treatment: simple thoracic irrigation, pleural decortication, bronchial pleural fistula repair, thoracoplasty and other methods. The results showed that: out of the 68 patients, 7 patients were cured with fistula closure by receiving simple thoracic irrigation;20 patients were cured by receiving pleural decortication and fistula repair;38 patients were cured by receiving thoracoplasty and fistula repair;3 patients had long-term survival with chest tube drainage. Application of preoperative thoracic irrigation in patients with tuberculous bronchopleural fistula can effectively control thoracic infection and provide a favorable conditions for postoperative surgery, and thus improve the success rate of surgery.