关键词: 结核, 肺, 肺曲菌病, 共病现象, 肺切除术, 治疗结果

Abstract:

Objective To analyze the clinical value of surgical treatment for pulmonary tuberculosis complicated with pulmonary aspergillosis. Methods We retrospectively analyzed the clinical data of 74 patients who were diagnosed pulmonary tuberculosis complicated with pulmonary aspergillosis and treated by lung resection in Guangxi Zhuang Autonomous Region Longtan Hospital from 2007 to 2016, including surgical methods, operative outcomes, postoperative complications and follow-up. Results Of the 74 patients, 68 (91.9%) underwent elective operation and 6 (8.1%) underwent emergency operation, 73 (98.6%) patients’ operations were successful, whereas 1 patient died of massive hemorrhage during operation. Among them, lobectomy in 54 cases (73.0%), segmentectomy in 5 cases, pneumonectomy in 2 cases, compound lung resection in 9 cases and wedge resection in 4 cases were conduced. Postoperative complications occurred in 24 cases (32.4%). One case had postoperative bleeding and was cured by thoracotomy. One case had respiratory failure and was successfully cured by ventilator assisted breath. Atelectasis occurred in 5 cases. They were treated by branchofiberoscope suction sputum therapy, of whom 4 cases achieved lung reexpansion, whereas 1 patient was ineffective and developed secondary respiratory failure (he refused further treatment and died after discharge). Empyema occurred in 4 cases. Three had bacterial empyema and were cured by continuous chest drainage. One case had aspergillus empyema, and was treated by video assisted thoracoscopic debridement 15 months after operation. However, the pulmonary artery was ruptured during operation and massive hemorrhage occurred. Then left pneumonectomy assisted by extracorporeal circulation was conducted, but the hemorrhagic shock could not been corrected and the patient died. Alveolar-pleural fistula occurred in 5 cases, of whom 3 were cured by continuous chest drainage, and 2 were cured by iodophor pleurodesis plus continuous chest drainage. Bronchopleural fistula occurred in 1 case. He was cured by continuous chest drainage for 3 weeks. Pleural space occurred in 7 cases without treatment. Seventy-two patients were followed up, of whom 1 died during the period of follow-up. Seventy-one cases (96.0%) were cured, and no pulmonary tuberculosis or pulmonary aspergillosis recurred; the duration of follow-up was 1-48 months, with an average of (11±3) months. Conclusion By selecting appropriate pulmonary tuberculosis patients complicated with pulmonary aspergillosis for lung resection, high cure rate and acceptable complication rate and mortality rate can be achieved, and most patients can be cured.

Key words: Tuberculosis, pulmonary, Pulmonary aspergillosis, Comorbidity, Pneumonectomy, Treatment outcome