CAJ | 학술논문

目的探讨支气管结核所致重度支气管狭窄的外科治疗适应证、疗效及并发症相关因素.方法 1990年1月至2010年12月,外科治疗81例结核性支气管狭窄患者,男29例,女52例;年龄(36±12)岁.发病至治疗间隔时间4周～ 20年,平均3.2年.手术原因为支气管狭窄伴有不可逆性肺不张、肺毁损及支气扩张等后遗症76例(93.8％),大咯血2例,耐多药结核2例,肺癌1例.因大咯血急诊手术2例,择期手术79例.行全肺切除51例,肺叶切除16例,袖式切除11例,气管支气管节段性切除2例,剖胸探查1例.右侧手术20例,左侧61例.结果无术中及术后死亡.9例(11.1％)并发症,包括支气管胸膜瘘2例,肺部感染2例,脓胸、出血性休克、血胸、切口感染和乳糜胸各1例.经对症及对因治疗均痊愈.Logistic回归分析显示毁损肺是术后并发症发生的独立危险因素(P＜0.05).远期死亡3例,5年生存率为96.2％.结论外科手术治疗结核性支气管狭窄并发症发生率低,疗效满意.对于药物及腔内治疗无效且伴有肺内不可逆病变的重度结核性支气管狭窄应积极考虑手术,避免肺毁损,增加手术治疗的风险.
목적 탐토지기관결핵소치중도지기관협착적외과치료괄응증、료효급병발증상관인소.방법 1990년1월지2010년12월,외과치료81례결핵성지기관협착환자,남29례,녀52례;년령(36±12)세.발병지치료간격시간4주～ 20년,평균3.2년.수술원인위지기관협착반유불가역성폐불장、폐훼손급지기확장등후유증76례(93.8％),대각혈2례,내다약결핵2례,폐암1례.인대각혈급진수술2례,택기수술79례.행전폐절제51례,폐협절제16례,수식절제11례,기관지기관절단성절제2례,부흉탐사1례.우측수술20례,좌측61례.결과 무술중급술후사망.9례(11.1％)병발증,포괄지기관흉막루2례,폐부감염2례,농흉、출혈성휴극、혈흉、절구감염화유미흉각1례.경대증급대인치료균전유.Logistic회귀분석현시훼손폐시술후병발증발생적독립위험인소(P＜0.05).원기사망3례,5년생존솔위96.2％.결론 외과수술치료결핵성지기관협착병발증발생솔저,료효만의.대우약물급강내치료무효차반유폐내불가역병변적중도결핵성지기관협착응적겁고필수술,피면폐훼손,증가수술치료적풍험.
Objective Severe bronchial stricture due to endobronchial tuberculosis is often accompanied by complex complication,such as obstructiv pneumonia,destroyed lung and bronchiectasis.Its treatment is very diffucult.The present report is to investigate and analyze the indication and efficacy of surgical treatment of bronchial stricture due to severe endobronchial tuberculosis.Methods Reviewed the clinico-pathological records documenting the surgical outcomes in 81 bronchial stricture due to severe endobronchial tuberculosis who underwent lobectomy or pneumonectomy enrolled in our hospital between January 1990 and December 2010.There were 29 male and 52 female.Mean age was(36 ± 12) years (ranged 16-66 years).The three most common reasons of surgery were bronchial stricture accompanied by pulmonary atelectasis,destroyed lung and bronchiectasis(76 cases,93.8％).79 cases had elective operation,whereas one patients required emergency surgery.Pueumonectomy in 51,lobectomy in 16,sleeve resection in 11,segmental resection in 2,and exploratory thoracotomy in 1.If frozen pathological examination showed that endobronchial tuberculosis remained in the bronchial stump,it was covered with muscle flaps,including intercostal muscle flap in 6 cases,latissimus dorsi muscle flap in 5 cases,serratus anterior muscle flap in 5 cases.The mean operative time was 3.2 h (range between 2 h and 5.5 h) and the blood loss averaged 546 ml (range between 100ml and 4 000 ml).The post operative hospital stay averaged(12 ±8)days.Results No intraoperative or early postoperative death occurred.Nine patients developed complications,including BPF in 2,pulmonary infection in 2,empyema in 1,hemorragic shock in 1,hemothorax in 1,incision infection in 1,chylothorax in 1.All 9 cases recovered well after treatment.Pathological examination showed that tuberculosis bronchial remained in the brinchial stump in 13 cases.Neither BPF nor empyema occurred in all the 13 cases.Multivariate analysis revealed that destroyed lung was significant risk factor of postoperative complication.There were 3 late deaths.Five year survival rate was 96.2％.Conclusion Surgical treatment is still the recommeded treatment modatity for bronchial stricture caused by endobronchial tuberculosis due to its excellent results.It should be performed in time when the drug and intraluninal treatment were no effect for avoiding of being progeressed into destroyed lung.