胸腔镜微创手术治疗矽肺叁期并发肺结核与继发性气胸

A case report of stageⅢsilicosis complicated by pulmonary tuberculosis and secondary pneumothorax treated with minimally invasive thoracoscopic surgery

目的分析采用胸腔镜微创手术治疗矽肺叁期并发肺结核、继发气胸的可行性。方法回顾性分析1例矽肺叁期并发肺结核、继发气胸患者的临床资料。结果患者为矽肺叁期并发活动性肺结核,病程1.5年;2021年3月发生左侧气胸,行胸腔闭式引流术进行保守治疗。2022年4月主诉“突发频繁咳嗽、左侧胸部闷胀”入院治疗,结合其职业史、粉尘接触史、后前位高千伏胸片、胸部计算机断层扫描和痰涂片检查结果,诊断其为“矽肺叁期;活动性结核(痰涂片查抗酸杆菌阳性);左侧胸腔积液、肺大泡破裂;继发性气胸(左侧复发性张力型,右侧包裹性),左侧胸膜黏连”。入院第2天行左侧胸腔闭式引流术,治疗效果差;入院第5天予胸腔镜微创治疗,行左肺减容、胸膜黏连烙断和胸膜固定术。术后给予抗炎、抗结核和对症支持治疗。因患者基础疾病严重,术后创面修复较慢;但其未发生其他严重并发症。术后17.0 d气胸完全吸收愈合。结论胸腔镜微创治疗矽肺并发肺结核、继发性气胸有效,值得推广。

Objective To analyze the feasibility of using minimally invasive thoracoscopic surgery to treat stageⅢsilicosis complicated by pulmonary tuberculosis and secondary pneumothorax.Methods This study retrospectively analyzed the clinical data of a patient with stageⅢsilicosis complicated by pulmonary tuberculosis and secondary pneumothorax.ResultsThe patient had stageⅢsilicosis complicated with active pulmonary tuberculosis for 1.5 years.In March 2021,a left-sided pneumothorax occurred and was conservatively treated with closed chest drainage.In April 2022,the patient was admitted with sudden frequent coughing and left-sided chest discomfort.Based on occupational history,dust exposure history,high-kilovolt anterior-posterior chest radiography,chest computed tomography,and sputum smear results,the diagnosis was"stageⅢsilicosis;active tuberculosis(positive for acid-fast bacilli in sputum smear);left-sided pleural effusion,pulmonary bulla rupture;secondary pneumothorax(recurrent tension type in left,encapsulated in right);left pleural adhesion".On the second day of admission,left-sided closed chest drainage was performed with poor outcome.On the fifth day of admission,minimally invasive thoracoscopic treatment was performed,including left lung volume reduction,pleural adhesion cauterization,and pleural fixation.Postoperative anti-inflammation,anti-tuberculosis,and symptomatic supportive treatments were administered.Due to the patient's severe underlying disease,wound healing was slow postoperatively,but no serious complications occurred.The pneumothorax completely absorbed and recovered in 17.o days.ConclusionMinimally invasive thoracoscopic surgery is an effective treatment for silicosis complicated with pulmonary tuberculosis and secondary pneumothorax,and it is worth promoting.