CAJ | 학술논문

目的：探索建立早期外科干预耐多药肺结核最佳手术时机的评估方法,以降低耐多药肺结核患者的住院费用及手术并发症发生率。方法以中华医学会结核病分会的《临床技术操作规范》(结核病分册)为基礎,根据患者的病变特点、术前用药、身体状况及手术方式等建立一简单实用的LTB-S最佳手术时机判断方法；同时,按照LTB-S分类方法,将耐多药肺结核外科手术的病人分为Ⅰ、Ⅱ、Ⅱ类。随机选择已手术的30例耐多药肺结核手术病人进行验证分析。结果随机选择的30例耐多药结核病人无1例手术死亡。手术方式：肺叶切除15例,全肺切除5例,肺局限病灶清除8例,胸膜肺全切2例。并发症：支气管胸膜瘘2例,术后对侧播散3例,二次进胸止血1例,术后伤口裂开2例。按LTB-S分类方法,I类手术并发症1例,Ⅱ类手术并发症2例,Ⅲ类手术并发症5例。随访4个月-12年,未治愈2例,复发0例。结论 LTB-S可以作为耐多药肺结核最佳手术时机的判断方法,值得临床推广。
목적：탐색건립조기외과간예내다약폐결핵최가수술시궤적평고방법,이강저내다약폐결핵환자적주원비용급수술병발증발생솔。방법이중화의학회결핵병분회적《림상기술조작규범》(결핵병분책)위기초,근거환자적병변특점、술전용약、신체상황급수술방식등건립일간단실용적LTB-S최가수술시궤판단방법；동시,안조LTB-S분류방법,장내다약폐결핵외과수술적병인분위Ⅰ、Ⅱ、Ⅱ류。수궤선택이수술적30례내다약폐결핵수술병인진행험증분석。결과수궤선택적30례내다약결핵병인무1례수술사망。수술방식：폐협절제15례,전폐절제5례,폐국한병조청제8례,흉막폐전절2례。병발증：지기관흉막루2례,술후대측파산3례,이차진흉지혈1례,술후상구렬개2례。안LTB-S분류방법,I류수술병발증1례,Ⅱ류수술병발증2례,Ⅲ류수술병발증5례。수방4개월-12년,미치유2례,복발0례。결론 LTB-S가이작위내다약폐결핵최가수술시궤적판단방법,치득림상추엄。
Objective To explore a optimal surgery time based onsurgical mark forward for multi-drug resist-ant tuberculosis patients ( MDR-TB) , in order to reduce the medical costs and complications. Methods We set up a simple LTB-Spractical judgment system according to patients′ disease characteristics, preoperative medication, physical condition and operation methods. And the patients were divided into classⅠ,Ⅱ andⅢ. 30 MDR-TB pa-tients were randomly chosen for this analysis. Results 30 MDR-TB patients were all survival. There were 15 cases of lobectomy, 5 cases of pneumonectomy, 8 cases of limited lung lesions cleared, and 2 cases of pleural lung cut. For complications, there were 2 cases of post-pneumonectomy fistula, 2 cases of contralateral spread, 1 case of secondary bleeding, and 2 cases into the chest of postoperative wound dehiscence. According to LTB-S classification method, 1 case was in classⅠ, 2 cases were in classⅡ, and 5 cases were in class Ⅲ. All of them were followed-up for 4 months to 12 years, and 2 cases did not cure and no recurrence occurred. Conclusion LTB-S judging system can be used as the optimal timing of surgery for judgment method.