空洞清除术治疗复治菌阳空洞型肺结核临床探究.docVIP

空洞清除术治疗复治菌阳空洞型肺结核临床探究 　　　【摘要】　目的　寻找通过外科手段治疗内科无法根治的复治耐多药菌阳重症空洞型肺结核的有效途径。方法　1981～1998年6月采用空洞清除术治疗复治耐药空洞型肺结核104例。切除覆盖在空洞外侧的肋骨后段，游离相应部位的带蒂肋间组织，剪除空洞外侧壁，彻底清除空洞内容物，刮出新鲜创面，有机酸杀灭可能残留的结核分支杆菌，将准备好的肋间肌瓣填充于空洞残腔内，缝合固定。结果　104例中出院时治愈103例(99.0%)，其中一次手术治愈101例(98.1%)，好转1例(1.0%)。随访98例中，复工率96%，无手术死亡和复发者。结论　空洞清除术设计合理，是治疗内科无法根治的复治菌阳空洞型肺结核的有效方法。 　　Cleaning cavity operation in treating relapse bacillary cavitary pulmonary tuberculosis 　　【Abstract】　Objective　To study the effective surgical way for serious relapse multidrug resistant bacillary cavitary pulmonary tuberculosis. Methods　104 cases of serious relapse multidrug resistant bacillary cavitary pulmonary tuberculosis were cured by cleaning cavity operation from 1981 to 1998. The operation contained resecting the back rib covering the cavity, separating the intercostal tissue, cutting the external wall of the cavity, cleaning the cavity thoroughly, scraping the cavity till exposing the fresh tissue, killing the tuberculosis germs with organic acid, filling the cavity with the intercostal muscle, fixing and suturing the muscles. Results　Among the 104 cases, 103 cases (99.0%) were cured, 101 cases (98.1%) were cured after the first operation, one caseamp;nbs p;(1.0%) became better. Among the 98 cases follwed up, the rate of returning to work were 96%, no one died or relapsed. Conclusions　The design of cleaning cavity operation is reasonable and it is the effective method to treat the relapse bacillary cavitary pulmonary tuberculosis, the rate of cure and sputum conversion are promising. 　　【Key words】　Tuberculosis, pulmonary　　Cleaning cavity operation 　　结核病的发病率在全球范围内有上升趋势，复治耐药病例不断增加，成为结核病防治工作中的难题［1］。我院胸外科自1981年开始设计并应用空洞清除术治疗复治耐药空洞型肺结核，到1998年6月共治疗104例，收到良好效果，报告如下。 　　对象与方法 　　一、对象 　　为(1)经长期规律或不规律抗结核治疗的复治菌阳病例；(2)耐多药(至少对异烟肼和利福平产生耐药者)；(3)位于上叶或下叶背段的4.0 cm以上的纤维厚壁空洞；(4)由于余肺病变较多，或心肺功能较差，不能承受或不适合行肺切除及萎陷手术者；(5)合并脓胸或双侧巨大厚壁空洞；(6)有咯血、感染及明显的临床症状者。 　　按上述标准，共选出104例，其中男性73例，女性31例。年龄28～67岁，平均38岁。病程最长33年，最短2.8年，平均6年4个月。空洞最小4.0 cm，最大约20 cm×16 cm。右上空洞60例，