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中国防痨杂志 ›› 2012, Vol. 34 ›› Issue (04): 245-247.

• 学术讨论 • 上一篇    下一篇

“LTB-S”分类法与耐多药肺结核手术适应证探讨

宋言峥 王旭 卢水华 肖和平   

  1. 201508上海市(复旦大学附属)公共卫生临床中心外科(宋言峥、卢水华); 河南省胸科医院胸外科(王旭);同济大学附属上海市肺科医院结核科(肖和平)
  • 收稿日期:2011-10-08 出版日期:2012-04-10 发布日期:2012-06-14
  • 通信作者: 宋言峥 E-mail:yanzhengsong@163.com

The value of LTB-S classification in surgical indication for multidrug-resistant tuberculosis

SONG Yan-zheng,WANG Xu,LU Shui-hua,XIAO He-ping   

  1. Department of Surgery,Shanghai Public Health Clinical Center, Public Health Clinical Center Affiliated to Fudan University,Shanghai 201508, China
  • Received:2011-10-08 Online:2012-04-10 Published:2012-06-14
  • Contact: SONG Yan-zheng E-mail:yanzhengsong@163.com

摘要: 目的  探讨“LTB-S”分类法在耐多药肺结核手术适应证方面的价值,以减少肺结核患者的手术并发症和医疗费用。 方法  以中华医学会结核病学分会的《临床技术操作规范结核病分册》为依据,建立一套简单实用的“LTB-S”最佳手术时机判断系统,将耐多药肺结核外科手术患者分为Ⅰ类(绝对手术适应证)、Ⅱ类(相对手术适应证)、Ⅲ类(无手术适应证)。同时选择现有的已手术的27例肺结核手术患者进行验证分析。 结果  27例患者中,Ⅰ类8例,Ⅱ类17例,Ⅲ类2例,符合“LTB-S”最佳手术时机判断原则的Ⅰ类患者无并发症发生,Ⅱ类和Ⅲ类患者各出现2例手术并发症,其中Ⅲ类患者手术并发症发生率100%(2/2)。随访4个月至12年,2例Ⅲ类患者未治愈,其余患者均治愈。 结论  LTB-S判断系统有助于耐多药肺结核患者最佳手术适应症的判断,具有实用的临床价值,适宜在临床中推广应用。

关键词: 结核, 肺/外科学, 抗药性, 多种, 细菌, 外科手术, 选择性

Abstract: Objective  To explore the value of LTB-S classification in surgical indication for multidrug-resistant tuberculosis, looking for a judging system of the optimal operation time in patients with multidrug-resistant tuberculosis to reduce the complications and medical costs.   Methods  We set up a simple practical LTB-S judgment system for surgery of multidrug-resistant tuberculosis based on《Clinical technology operating specifications(tuberculosis section)》 written by Chinese Medical Association Tuberculosis Branch.Patients were divided into class Ⅰ, Ⅱ, Ⅲ which definited absolute sugery indication, relative indication and contraindication, respectively. Twenty-seven cases with pulmonary tuberculosis who has been underwent surgery were randomly chosen for this confirmatory analysis.   Results  Of 27 patients, 8 patients belonged to class Ⅰ, 17 class Ⅱ, and 2 class Ⅲ in those who complied with the LTB-S class Ⅰ had no complications,the patients which complied with the LTB-S class Ⅱ and Ⅲ have much more complications which incidence were 2 patients(100% in class Ⅲ), respectively.  Conclusion  LTB-S judging system is helpful for the judgment of operative indications for multidrug-resistant tuberculosis,it is very practical on clinical  and suitable for TB physicians learning and understanding.

Key words: Tuberculosis,pulmonary/surgery, Drug resistance,multiple, bacterial, Surgical procedures,elective