关键词: 结核, 肺, 结核性毁损肺, 肺切除术, 治疗结果

Abstract:

Objective To explore the clinical application of pulmonary surgical treatment for tuberculosis destroyed lung.Methods Clinical data of 487 patients with tuberculosis destroyed lung who were admitted to the Chengdu Public Health Clinical Medical Center from January 2007 to March 2017 were collected. All the patients underwent surgical treatment 2 weeks after standard anti-tuberculosis drugs (individualized regimens), with stable tuberculosis, improved preoperative examination, and indications for surgery. Clinical symptoms before and after surgery were compare, as well as changes in thoracic collapse, scoliosis, sputum test, lung function changes, surgical procedures, complications and follow-up. Data were analyzed by t test using SPSS 17.0 software, and P<0.05 was considered statistically significant.Results Among the 487 patients in, 93 underwent right upper lung resection, 69 underwent right pneumonectomy, 112 underwent left upper lung resection, 193 patients underwent left pneumonectomy, and 20 patients underwent double supra-pulmonary resection. Obvious cough, chest tightness, shortness of breath, and collapse of the affected chest were found in 453 patients, mediastinum were significantly biased to the affected side in 78 cases, repeated hemoptysis was found in 385 cases, 113 cases were with massive hemoptysis, repeated massive hemoptysis exsit in 32 cases; sputum test was positive in 82 cases (47 were smear positive patients and 35 were sputum positive), 57 patients were found positive for acid-fast bacilli using fiberoptic bronchoscopy; Only 23 patients had mild cough and chest tightness after operation; the thoracic collapse was improved in patients undergoing pneumonectomy; the mediastinal shift was significantly restored in patients with non-pneumonectomy; blood in the sputum after 6-months-to-2-year follow-up was found in 5 patients; 151 sputum positive patients were all negative postoperative. The vital capacity (VC) was, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), maximum call Peak gas flow rate (PEF) , maximum ventilation (MVV), were all significantly improved after surgery((85.20±10.10)% vs. (67.50±11.37)%, t=-7.56, P=0.024) ((88.00±9.80)% vs. (71.60±13.21)%, t=-8.63, P=0.01) ((84.60±7.36)% vs. (66.10±10.03)%, t=-5.37, P=0.037)((80.65±9.25)% vs. (65.90±9.54)%, t=-6.40, P=0.022) ((83.20±5.73)% vs. (61.20±13.60)%, t=-4.66, P=0.012). Complications occurred in 53 patients(53/487, 10.88%) during 3days to 6months postoperativ, including thoracic infection (n=22, bronchial-pleural fistula in 5 cases), recruitment insufficiency in residual lung (n=13), severe pulmonary infection (n=7), wound infection (n=6), and hoarseness (n=5). One patient with right pneumonectomy died ofrespiratory failure 3 hours after surgery because of tight chest adhesion, operative timeover 9 hours, and an intraoperative blood loss of more than 2000ml. Of the patients, 433 patients recovered to normal life and work 3 to 6months after surgery; 25 patients recovered at home and have resumed daily life but did not go out to work; the total effective rate was 94.05% (458/487).Conclusion Based on standard and effective anti-tuberculosis drug, surgical treatment for patients with tuberculosis destroyed lung is of efficiency, with less complications, and could significantly improves lung function in, which is essential to improve patients’ quality of life and achieve cure in clinic.

Key words: Tuberculosis, pulmonary, Tuberculosis destroyed lung, Pneumonectomy, Treatment outcome