肺结核外科的微创伤疗法(附39例报告)

Microtrauma therapy in pulmonary tuberculosis surgery (39 cases report enclosed)

目的探讨微创伤疗法治疗肺结核病的可行性及治疗效果。方法收集接受微创伤疗法的肺结核病患者的临床资料进行回顾性分析。其中小切口或者电视胸腔镜下的肺结核肺切除术及脓胸廓清术患者10例(A组),小切口开胸下的肺结核空洞、结核球、曲菌球病灶清除术和不经胸局限性脓胸病灶清除术患者29例(B组)。结果A组在电视胸腔镜下肺叶切除8例,其中1例术后肺膨胀不良,造成上胸腔残腔积液,其余7例肺复张满意;拔管时间最短3 d,最长10 d;术后第2天患者均可下床活动。电视胸腔镜下结核性脓胸廓清术2例,其中1例肺完全复张,1例复张不完全。B组29例患者全部治愈,无支气管胸膜瘘、结核播散、窦道形成等手术并发症发生病例;住院时间较常规术式明显缩短;术后下床早,呼吸循环系统的恢复明显较肺切除患者快;术后引流量少,拔管时间平均2~4 d;术前局限型慢性纤维空洞型肺结核合并痰菌阳性的6例患者,术后5例转阴、空洞消失;其中1例痰菌量明显减少;2例合并曲菌球的患者术后咯血停止。6例不经胸局限性脓胸病灶清除术患者,术后切口一期愈合。患者随访4个月~12年,平均6.2年,未见复发及播散。结论微创伤疗法就切口而言,是介于传统开胸切口与微创切口之间的一种切口;就手术而言,比传统手术方式和微创手术方式损伤更小。肺结核病的外科治疗应择机选择微创伤疗法,其方法可行且效果良好。

Objective To study the feasibility and therapeutic effect of micro-trauma therapy in the treatment of pulmonary tuberculosis.Methods The results of patients with pulmonary tuberculosis and emphysema over the past 4 years treated by microtrauma therapy were collected and analyzed.Among them,10 patients(group A)underwent pulmonary tuberculosis resection and empyema clearance by small incision or video-assisted thoracoscopy,and 29 patients(group B)underwent subthoracic resection of pulmonary tuberculosis cavity,tuberculous ball,and aspergillus ball lesions and localized empyema clearance by small incision.Results In group A,among the 8 pulmonary tuberculosis cases who underwent video-assisted lobectomy,one case transferred to open chest,and found postoperative bad lung expansion,resulting in pleural effusion on the residual cavity,and the remaining 7 cases with satisfactory pulmonary reexpansion.Their extubation time was as short as 3 days mainly,maximum to 10 days.All patients could get out of bed on the 2nd day after the operation.Video assisted thoracoscopic tuberculous empyema clearance was performed in 2 patients,including 1 patient with complete pulmonary reexpansion and 1 patient with incomplete pulmonary reexpansion.In group B,all 29 cases were cured,with no bronchopleural fistula,no spread of tuberculosis,no sinus formation and other postoperative complications.Their hospital stay was significantly shorter than that of conventional operation.Patients could walk around the bed earlier.Their postoperative recovery of respiratory and circulatory system was faster than that of pulmonary resection patients with less postoperative drainage,extubation time averaging 2-4 days.There were 6 patients with preoperative localized chronic fiber-cavitary pulmonary tuberculosis and positive sputum bacteria,of which 5 cases turned to smear-negative after operation and one showed a significant decrease in the quantity of sputum bacteria.Hemoptysis stopped in the 2 patients complicated with aspergilloma after operation.All patients have been followed up for 4 months-12 years,an average of 6.2 years without recurrence or spread.Conclusions The method of minimally invasive wound treatment is a kind of incision which is related to the traditional thoracotomy incision and the micro-invasive incision,and in terms of manual method,the damage is less than the traditional manual method and the mini-invasive method.The surgical treatment of pulmonary tuberculosis should be changed gradually to the treatment of micro-trauma,which is feasible and effective.