目的探讨肺结核合并支气管胸膜瘘诊断治疗。方法采用回顾性分析法对我院2008年1月-2014年6月期间收治的49例肺结核合并支气管胸膜瘘患者的临床资料进行分析总结。49例中,在院外因肺结核行手术治疗后出现支气管胸膜瘘13例;36例因患肺结核发生支气管胸膜瘘,包括15例结核性肺毁损合并支气管胸膜瘘(2例合并曲霉菌感染),12例结核性脓气胸合并支气管胸膜瘘,9例结核性肺毁损伴结核性脓胸合并支气管胸膜瘘;所有患者均由结核内科专家组调整抗痨方案,院外13例进行正规抗痨治疗及通畅引流,有2例进行了手术治疗;本院36例肺结核并支气管胸膜瘘患者,均接受手术治疗。结果院外13例患者经过保守治疗3月后10例痊愈,未愈的3例中2例行了开胸行瘘口修补术,1例治愈,1例2周后再次出现支气管胸膜瘘,在术后51天死于全身衰竭,另一例拒绝手术于2月后再次调整抗痨方案后失访;36例肺结核合并支气管胸膜瘘给予手术治疗,术后6月自行停药,2例在两例分别在术后7、9月出现支气管胸膜瘘,肺结核播散,经过我院结核内科专家组调整抗痨方案及通畅引流后3月自行愈合。49例患者中除1例失访,1例死于全身衰竭,其余47例患者均随访1-6年未有再发支气管胸膜瘘,所有患者均坚持抗痨足疗程(最长的达30个月)。合并曲霉菌感染者,术后即给予伏立康唑治疗4-6周。结论肺结核合并支气管胸膜瘘是胸外科治疗的难点。防止肺结核手术出现支气管胸膜瘘的最基本的前提是抗痨治疗必须有效,术后必须坚持足疗程抗痨治疗;手术的关键是支气管残端的处理:术中支气管外膜剥离不能太骨骼化,支气管残端保留不宜超过25px,最好用机械闭合器处理残端,用NEOVEIL补片加固,全肺切除者再用周围胸膜包埋使之纵隔化。
目的 探讨感染人类免疫缺陷病毒/患艾滋病(HIV/AIDS)胸外科患者的临床特征及围手术期处理。方法 对我院胸外科2010.1-2012.12收治的19例合并HIV/AIDS患者的临床资料进行回顾性分析。结果 本组19例中18例行了外科手术治疗:肿瘤患者行了肿瘤切除+淋巴结清扫术;复发性气胸患者行了VATS肺大疱切除及胸膜固定术;肺脓肿、肺结核合并曲霉菌感染及支气管金属异物患者行了肺叶切除术;胸壁结核患者行了胸壁结核病灶清除术;心包金属异物患者行了异物取出术。全组无手术死亡病例。术后1例开胸患者出现肺不张,1例开胸患者出现包裹性胸腔积液,并发症发生率11.1%(2/18),经过积极对症治疗4周后上述情况明显改善。术后1例气胸患者随访3月后失访,其余17例随访6月-2.5年,肿瘤患者未发现有复发转移,气胸、胸壁结核、肺结核及肺脓肿等均未复发。结论 早期合并HIV/AIDS胸外科患者的临床特征与普通胸外科患者相比无特殊,但处于AIDS发病期的患者合并症较多;HIV/AIDS胸外科患者的手术指征与普通胸外科患者基本相同,通常需要结合患者CD4+T淋巴细胞计数与患者的具体情况来确定手术时机;合并HIV/AIDS的早期胸外科患者手术并发症与普通胸外科患者无区别,合并AIDS的晚期胸外科患者术后并发症多且较严重,一般与患者CD4+T淋巴细胞计数呈正相关。
目的:探讨肺结核合并支气管扩张的外科治疗。方法:对我科2008年1月—2010年12月收治的29例肺结核合并支气管扩张患者的临床资料进行分析总结。结果:29例患者均获手术切除病灶。术后病理证实均为肺结核合并支气管扩张,其肺部均有结核病灶,其中合并空洞12例,合并曲霉菌感染9例;术后再发痰中带血1例,并发症发生率3.4%,本组无死亡病例。结论:外科手术切除病灶是治疗肺结核合并支气管扩张最有效的方法。
摘要 目的:探讨慢性结核性脓胸的治疗方式。方法:采用临床随机对照试验对我院2008年1月—2010年12月收治的部分慢性结核性(符合研究要求)脓胸进行分组治疗(手术组、非手术组)研究,手术组在正规有效抗痨基础上进行脓胸清除+纤维板(增厚的胸膜)剥脱术,术后继续正规抗痨治疗;对照组(非手术组)采用仅内科正规有效抗痨治疗,对比两组治疗前后的病情变化。结果:手术组经过手术治疗后脓胸消除,胸廓的塌陷得到遏制,多数患者可以使塌陷胸廓得到改善,肺功能均有明显改善,生活质量得到改善;而对照组治疗前后症状无明显改善,反而自觉胸闷、胸痛、气紧等症状多有加重,胸廓塌陷更明显,肺功能继续恶化,生活质量变差。结论:外科手术是治疗慢性结核性脓胸的最佳方式。关键词 慢性结核性脓胸 抗痨 外科手术 胸膜剥脱Treatment of chronic tuberculous empyema【Abstract】Objective To investigate the treatment of chronic tuberculous empyema. Methods A clinical randomized controlled trials (met the study requirements) chronic tuberculous empyema admitted to our hospital from January 2008 to December 2010,grouping of treatment (surgery group, non-surgical group);On the basis of effective formal anti-tuberculosis the surgery group adopted the removal of empyema and stripping of fiber board ( thickening of the pleura) operation, postoperative continued regular anti-tuberculosis treatment;Control group used regular effective anti-tuberculosis treatment only medical condition changes;The changes of two groups was compared before and after treatment. Results After operation surgical group empyema had been cleared and the collapse of the thorax had been checked, the majority of patients could be improved the collapse of the thorax, lung function was significantly improved ,and quality of life improved; Control had no significant improvement in symptoms before and after treatment, and consciously chest tightness,chest pain,tight gas and other symptoms were more aggravated thoracic collapse, pulmonary function and quality of life continued to deteriorate. Conclusion Surgery is the best way for the treatment of chronic tuberculous empyema.【Key words】Chronic tuberculous empyema Anti-tuberculosis Surgery Pleurodesis.
摘要 目的:探讨肺结核合并曲霉菌感染的诊断和外科治疗。方法:对我科2008年1月—2010年12月收治的38例肺结核合并曲霉菌感染患者的临床资料进行分析总结。结果:38例患者均获手术切除病灶。术后病理证实均为肺结核合并肺曲菌感染,其基础疾病包括结核性空洞17例,结核性肺毁损12例,结核性支气管扩张症9例;18例术前已明确合并有曲霉菌感染,占47.4%;术前漏诊20例,漏诊率为52.6%;术后再发痰中带血1例,并发症发生率2.6%,本组无死亡病例,术后随访1-3年未再发曲霉菌感染。结论:肺结核合并曲霉菌感染漏诊率高;手术切除病灶是治疗肺结核合并曲菌感染最有效的方法。关键词 肺结核、曲霉菌感染、外科手术The diagnosis and surgical treatment of Pulmonary Tuberculosis complicated with Aspergillus infection【Abstract】Objective: To sdudy the diagnosis and surgical treatment of Pulmonary Tuberculosis complicated with Aspergillus infection. Methods: Analysis the clinical data of 38 patients who suffering from Pulmonary Tuberculosis complicated with Aspergillus infection treated in our department from January 2008 to December 2010. Results:38 patients obtained operation excision of the lesion. The postoperative pathology confirmed Pulmonary Tuberculosis with Aspergillosis infection, of which,17 cases with tuberculosis cavity, 12 cases with tuberculousis destroyed lung, 9 cases with Tuberculous bronchiectasis; 18 cases in the preoperative has been clearly complicated with Aspergillus infection, accounting for 47.4%;20 cases were missed diagnosis before operation, the missed diagnosis rate was 52.6%; 1 cases recurred hemoptysis in the postoperative, the complication rate was 2.6%, with no deaths in this group, the patients were followed-up for 1 to 3 years without recurrence of Aspergillus infection. Conclusion: Misdiagnosis rate of Pulmonary Tuberculosis combined Aspergillus infection is high;Operation excision of the lesion is an effective treatment way of the Pulmonary Tuberculosis complicated by Aspergillosisinfection.【Key words】 Pulmonary tuberculosis, Aspergillus infection, Surgical operation
【摘要】目的:探讨结核性毁损肺的治疗方式。方法:采用临床随机对照研究对我院2008.1—2010.12收治的部分结核性毁损肺(符合研究条件)进行分组治疗(手术及非手术组)研究。手术组在正规抗痨2周后完善相关术前检查(结核活跃者要待结核稳定后),行毁损肺切除,本组无一例患者行胸廓成形术;非手术组一直正规抗痨治疗;两组抗痨方案均由结核内科专家组制定;对比两组治疗前后的变化。结果手术组共37例,死亡1例,并发症3例,36例患者术后随访1~3年,胸闷、气紧等症状均较术前明显好转,特别是痰菌全部阴转,咳血症状未再发,多数患者在术后3~6月后恢复了日常生活及工作。非手术组39例一直采用内科正规抗痨,2例在治疗3月后因咳血次数及量明显增加要求手术治疗而退出本研究,余37例患者随访1~3年,胸闷、气紧及咳血等症状无明显缓解,而且有部分患者咳血等症状较前有所加重。结论结核性毁损肺是一种不可逆的肺实质病变,需要在正规抗痨治疗基础上采用外科手术切除病肺,才能达到治愈的目的。【关键词】 结核性毁损肺 抗痨 外科手术【Abstract】 Objective: To investigate the treatment of tuberculous lung. Methods: A randomized controlled clinical study admitted to the patients,who suffering from tuberculous destroyed lung in our hospital from January 2008 to December 2010 (met the study requirements), grouping of therapy (surgery, non-surgical group) study. Improve the related preoperative examination two weeks after the regular anti-TB(If active TB, needing TB stabilized before surgery),the surgery group had been taken the destroyed lung resection. There was no case of patients with thoracoplasty; group has been regular anti-tuberculosis treatment; Two anti-tuberculosis program non-surgical by the TB medical expert group to develop; Changes was compared in the two groups beforeand after treatment. Results: There was a total of 37 cases in the operation group, 1 died, 3 cases with complications, 36 cases were followed up for 1 to 3 years, compared with preoperative chest tightness, tight gas and other symptoms improved markedly;In particular, all turned negative sputum, hemoptysis did not relapse, the majority of patients after 3 to 6 months daily life and work (no heavy work) recovered. 39 cases of non-surgical group has been using formal medical anti-tuberculosis, two cases required surgical treatment withdrew from the study because of the frequency and quantity of hemoptysis increased significantly after 3 months of treatment, 37 patients were followed up for 1 to 3 years, the symptoms of chest tightness, tight gas and hemoptysis without significant relief, and hemoptysis symptoms in some patients than before is aggravated. Conclusion: Tuberculous destroyed lung is an irreversible lung parenchymal disease. In order to achieve the purpose of healing,it needs to surgical operation excision of diseased lungs on basis of regular anti-tuberculosis treatmentd .【Key words】 Tuberculous destroyed lung; Anti-tuberculosis; Surgery
【Abstract】 Objective To investigate the clinical features and the surgical treatment of chest wall tuberculosis. Methods Clinical data of totally 157 patients with chest wall tuberculosis who were treated from July 2003 to June 2009 were analyzed retrospectively. Results All patients were pathologically confirmed chest wall tuberculosis and cured after surgery. Only 2 cases had re-operation because of recurrence before discharging; 5 patients had local skin necrosis. After discharge, all patients were been followed up from 10 months to 6 years and no one had recurrence lesion. Conclusion The clinical focuses of chest wall tuberculosis are usually very hiding and very poly-morphological; surgical management may eliminate the TB lesions, but the operation is not an atypical surgery; effective and full course of anti-tuberculosis drug therapy must been given around the surgery; and completely clean away lesions, eliminate potential lacunars during operation and administer proper postoperative management, all of these are very important factors for successful operations and avoiding recurrence of tuberculosis lesions.【Key words】 Chest wall tuberculosis, Clinical features, Diagnosis, Surgical treatment
胸壁结核的临床特点具有隐匿性、多形性,外科手术治疗效果好。胸壁结核病灶清除术为不定型手术,手术前后必须正规、有效、足疗程抗痨,术中彻底清除病灶、消灭死腔及术后正确的管理,是手术成功、避免复发的关键。
目的 探讨肺硬化性血管瘤(PSH)的临床特点、诊断和治疗,提高对PSH的认识。 方法 回顾分析自1990年1月~2005年12月我们收治的39例PSH的临床资料。结果 本组中无1例患者术前得到确诊。女性占92.31%(36/39),患者平均年龄41.69岁,无症状占53.84%(21/39)。影像学表现为圆形或类圆形软组织结节影35例(89.14%),密度均匀30例(76.92%),病灶有钙化的13例(33.33%),位于肺周边的占35例(89.74%)。本组所有患者均行手术切除,术后有3例出现并发症(7.69%),无手术死亡患者。术后除2例失访,其余均随访1.5~5年,随访率94.87%,均无复发。 结论 PSH缺乏特异的临床症状和影像学表现,术前确诊困难,确诊依靠病理检查,外科手术是目前治疗PSH的唯一有效方法。【关键词】肺硬化性血管瘤;诊断;外科治疗