中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2014年
3期
141-144
,共4页
赵攀%蒋明英%谢渝中%曾小刚
趙攀%蔣明英%謝渝中%曾小剛
조반%장명영%사투중%증소강
结核,肺%肺切除术%药物疗法,联合%手术后并发症
結覈,肺%肺切除術%藥物療法,聯閤%手術後併髮癥
결핵,폐%폐절제술%약물요법,연합%수술후병발증
Tuberculosis,pulmonary%Lobectomy%Drug therapy,combination%Postoperative complications
目的 探讨耐多药肺结核外科治疗的手术时机和手术联合药物化学治疗耐多药肺结核的临床效果,为优化耐多药肺结核外科治疗方案提供循证医学依据.方法 随机数字表法抽取2003年7月至2010年6月耐多药肺结核患者100例,分为对照组和观察组各50例.患者均经药敏试验确诊,具肺叶切除指征.对照组进行内科化疗;观察组进行手术治疗,术后继续予以药物化疗12 ～ 24个月.所有患者随访24个月.根据病程长短将观察组病例分为不同亚组,统计不同亚组患者术后治疗效果,比较病程2年内与2年以上患者的治愈率、并发症发生率、病死率等指标.结果 随访期末,对照组治愈率36.0％(18/50),病情逆转率16.0％(8/50),病死率26.0％(13/50),新出现耐药率6.0％(3/50);观察组治愈率80.0％(40/50),病情逆转率2.0％(1/50),病死率4.0％ (2/50),未出现新耐药病例.两组病情逆转率差异有统计学意义(P＜0.05),治愈率、病死率比较差异有统计学意义(P＜0.01).观察组病程2年内患者的治愈率96.3％、并发症发生率3.7％,病程2年以上患者的治愈率47.8％、并发症发生率43.5％,组间差异均有统计学意义(P＜0.01),病死率差异无统计学意义(P＞0.05).术后并发症主要有支气管胸膜瘘、术后出血、脓胸及肺不张等,常规处理后11例病情稳定,2例死于大咯血窒息及多器官功能衰竭.结论 手术联合化疗治疗耐多药肺结核优于单纯内科治疗.早期手术治疗效果优于晚期手术,手术并发症可接受.
目的 探討耐多藥肺結覈外科治療的手術時機和手術聯閤藥物化學治療耐多藥肺結覈的臨床效果,為優化耐多藥肺結覈外科治療方案提供循證醫學依據.方法 隨機數字錶法抽取2003年7月至2010年6月耐多藥肺結覈患者100例,分為對照組和觀察組各50例.患者均經藥敏試驗確診,具肺葉切除指徵.對照組進行內科化療;觀察組進行手術治療,術後繼續予以藥物化療12 ～ 24箇月.所有患者隨訪24箇月.根據病程長短將觀察組病例分為不同亞組,統計不同亞組患者術後治療效果,比較病程2年內與2年以上患者的治愈率、併髮癥髮生率、病死率等指標.結果 隨訪期末,對照組治愈率36.0％(18/50),病情逆轉率16.0％(8/50),病死率26.0％(13/50),新齣現耐藥率6.0％(3/50);觀察組治愈率80.0％(40/50),病情逆轉率2.0％(1/50),病死率4.0％ (2/50),未齣現新耐藥病例.兩組病情逆轉率差異有統計學意義(P＜0.05),治愈率、病死率比較差異有統計學意義(P＜0.01).觀察組病程2年內患者的治愈率96.3％、併髮癥髮生率3.7％,病程2年以上患者的治愈率47.8％、併髮癥髮生率43.5％,組間差異均有統計學意義(P＜0.01),病死率差異無統計學意義(P＞0.05).術後併髮癥主要有支氣管胸膜瘺、術後齣血、膿胸及肺不張等,常規處理後11例病情穩定,2例死于大咯血窒息及多器官功能衰竭.結論 手術聯閤化療治療耐多藥肺結覈優于單純內科治療.早期手術治療效果優于晚期手術,手術併髮癥可接受.
목적 탐토내다약폐결핵외과치료적수술시궤화수술연합약물화학치료내다약폐결핵적림상효과,위우화내다약폐결핵외과치료방안제공순증의학의거.방법 수궤수자표법추취2003년7월지2010년6월내다약폐결핵환자100례,분위대조조화관찰조각50례.환자균경약민시험학진,구폐협절제지정.대조조진행내과화료;관찰조진행수술치료,술후계속여이약물화료12 ～ 24개월.소유환자수방24개월.근거병정장단장관찰조병례분위불동아조,통계불동아조환자술후치료효과,비교병정2년내여2년이상환자적치유솔、병발증발생솔、병사솔등지표.결과 수방기말,대조조치유솔36.0％(18/50),병정역전솔16.0％(8/50),병사솔26.0％(13/50),신출현내약솔6.0％(3/50);관찰조치유솔80.0％(40/50),병정역전솔2.0％(1/50),병사솔4.0％ (2/50),미출현신내약병례.량조병정역전솔차이유통계학의의(P＜0.05),치유솔、병사솔비교차이유통계학의의(P＜0.01).관찰조병정2년내환자적치유솔96.3％、병발증발생솔3.7％,병정2년이상환자적치유솔47.8％、병발증발생솔43.5％,조간차이균유통계학의의(P＜0.01),병사솔차이무통계학의의(P＞0.05).술후병발증주요유지기관흉막루、술후출혈、농흉급폐불장등,상규처리후11례병정은정,2례사우대각혈질식급다기관공능쇠갈.결론 수술연합화료치료내다약폐결핵우우단순내과치료.조기수술치료효과우우만기수술,수술병발증가접수.
Objective To investigate the optimal timing of surgical treatment for multi-drug resistance patients,discuss the clinical effect of surgery with chemotherapy treatment for muhi-drug resistant tuberculosis,and obtain more evidence for further optimizing surgical treatment strategy for such patients.Methods 100 cases who were multi-drug resistant and who received treatment in our hospital from July 2003 to June 2010 were included in this retrospective study.Among them,50 (observation group) received pulmonary lobectomy followed by anti-tuberculosis chemotherapy for 12 to 24 months,and the others (control group) only received anti-tuberculosis regimens although they had indications for pulmonary lobectomy.All patients in both groups were followed up for 12 to 24 months.Therapeutic effects and post-operational events were compared statistically in the observation group patients according to their duration of disease.Results Results At the end of follow-up,the cure rate,illness exacerbation rate and mortality were 36.0％ (18/50),16.0％ (8/50) and 26.0％ (13/50) respectively in the control group,whereas those in the observation group were 80.0％ (40/50),2.0％ (1/50) and 4.0％ (2/50) respectively.Resistanee to new anti-tuberculosis drugs appeared in 3 cases (6％) in the control group,while there was no new resistance in the observation group.The cure rate and complication rate were 96.30％ and 3.70％ respectively for patients whose duration of illness was less than 2 years,whereas those were 47.8％ and 43.5％ respectively for cases whose duration of illness was more than 2 years.Bronchopleural fistula,hemorrhage,pyothorax and pulmonary atelectasis were main postoperative complications,from which 11 cases recovered and 2 died,the death caused by choking of big haemoptysisand and multiple organs failure.Conclusion The therapeutic effects of surgical treatment plus anti-tuberculosis chemotherapy were better than chemotherapy alone.Pulmonary lobectomy could result in better response if done at the earlier stages of illness.Complications of operations were acceptable.
