肺结核空洞伴曲霉菌感染并咯血的外科治疗
|
摘要
目的探讨外科手术治疗肺结核空洞伴曲霉菌感染并咯血的原则、方法及疗效。方法回顾性分析该院2013年1月-2016年12月收治的施行外科手术治疗肺结核空洞伴曲霉菌感染并咯血的25例患者临床资料。行胸腔镜辅助小切口治疗23例,标准后外侧切口2例。其中,右肺上叶切除13例,右肺下叶切除2例,左肺上叶切除6例,左肺下叶切除1例,左全肺切除1例,右肺上叶合并右肺下叶背段切除1例,右肺上中叶合并右肺下叶背段切除1例,全组未作胸廓成形术。结果围手术期死亡1例,为健肺肺部感染导致呼吸衰竭。局限性肺不张8例,心律失常7例,胸腔渗血1例,反复少量咯血1例,均采用相应治疗痊愈,复查胸部CT肺复张良好。术后失访2例,其余22例随访3~36个月,咯血、痰血消失,痰抗酸杆菌涂片均转阴,咳嗽、咳痰、胸闷和胸痛等症状明显缓解,生活质量提高,效果满意。结论外科手术治疗肺结核空洞伴曲霉菌感染并咯血的效果确切,安全可行,对于符合指征的患者应不失时机地进行手术治疗。
Objective To discuss the principle,method and effect of surgical treatment for pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis.Methods Retrospective analysis of surgical treatment of 25 cases of pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis from January 2013 to December 2016.23 cases applied Video-assisted Mini-thoracoscopy,while standard posterolateral incision for another 2 cases.The right upper lobectomy in 13 cases,right inferor lobectomy in 2 cases,left upper lobectomy in 6 cases,left inferor lobectomy in 1 case,left pneumonectomy in 1 case,right upper lobectomy with dorsal segmentectomy in 1 case,right middle and upper lobectomy with dorsal segmentectomy in 1 case.The whole group without thoracoplasty.Results 1 patient died of respiratory failure due to contralateral pulmonary infection.Segmental atelectasis in 8 cases,arrhythmia in 7 cases,pleural bleeding in 1 case,repeated hemoptysis of a small amount in 1 case,all the cured patients are received the corresponding treatment,2 patients were lost to followup,and the rest 22 patients were followed up form 3 months to 36 months,the effect was satisfactory and the quality of life was improved obviously.Conclusion Surgical treatment for pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis is safe, feasible and should be performed timely in these patients.
Objective To discuss the principle,method and effect of surgical treatment for pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis.Methods Retrospective analysis of surgical treatment of 25 cases of pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis from January 2013 to December 2016.23 cases applied Video-assisted Mini-thoracoscopy,while standard posterolateral incision for another 2 cases.The right upper lobectomy in 13 cases,right inferor lobectomy in 2 cases,left upper lobectomy in 6 cases,left inferor lobectomy in 1 case,left pneumonectomy in 1 case,right upper lobectomy with dorsal segmentectomy in 1 case,right middle and upper lobectomy with dorsal segmentectomy in 1 case.The whole group without thoracoplasty.Results 1 patient died of respiratory failure due to contralateral pulmonary infection.Segmental atelectasis in 8 cases,arrhythmia in 7 cases,pleural bleeding in 1 case,repeated hemoptysis of a small amount in 1 case,all the cured patients are received the corresponding treatment,2 patients were lost to followup,and the rest 22 patients were followed up form 3 months to 36 months,the effect was satisfactory and the quality of life was improved obviously.Conclusion Surgical treatment for pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis is safe, feasible and should be performed timely in these patients.
引文
[1]傅毅立,李辉,胡滨,等.全胸腔镜肺切除术治疗肺曲霉菌球的病例对照研究[J].中国胸心血管外科临床杂志,2015,22(6):564-568.[1]FU Y L,LI H,HU B,et al.Completely video-assisted thoracopic surgery treatment on pulmonary aspergilloma:a case control study[J].Chinese Journal of Clinical Thoracic and Cardiovascular surgery,2015,22(6):564-568.Chinese
[2]何嘉,陈野野,李单青.34例肺曲霉菌病的外科治疗[J].协和医学杂志,2013,14(3):318-322.[2]HE J,CHEN Y Y,LI S Q.Surgical treatment for pulmonary aspergillosis:report of 34 cases[J].Medical Journal of Peking Union Medical College Hospital,2013,14(3):318-322.Chinese
[3]蒋良双,吴邦贵,岳冀,等.肺结核病合并曲霉菌感染的诊断与外科治疗[J].中国胸心血管外科临床杂志,2013,20(3):312-316.[3]JIANG L S,WU B G,YUE J,et al.The diagnosis and surgical treatment of pulmonary tuberculosis complicated with aspergillus infection[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,2013,20(3):312-316.Chinese
[4]吴跃明,胡炜炜,冯江,等.肺曲霉菌病患者手术治疗的临床研究[J].中华医院感染杂志,2014,24(12):3008-3010.[4]WU Y M,HU W W,FENG J,et al.Clinical research for pulmonary aspergilloma patients with surgery[J].Chinese Journal of Nosocomiology,2014,24(12):3008-3010.Chinese
[5]韩俊垒,汤兵祥.陈旧性肺结核合并肺曲霉菌75例临床分析[J].河南医学研究,2011,20(1):76-78.[5]HAN J L,TANG B X.Clinical analysis of 75 cases of patients with old pulmonary tuberculosis combined with pulmonary aspergillosis[J].Henan Medical Research,2011,20(1):76-78.Chinese
[6]马丽,陈杭薇,李雪辉,等.肺曲霉菌病的临床研究进展[J].中华医院感染杂志,2016,26(16):3835-3837.[6]MA L,CHEN H W,LI X H,et al.Progress in clinical research of pulmonary aspergillosis[J].Chinese Journal of Nosocomiology,2016,26(16):3835-3837.Chinese
[7]梁建华,李远章,黄晓燕,等.陈旧性肺结核继发空洞性肺曲霉菌病CT分析[J].罕少见病杂志,2016,23(1):24-27.[7]LIANG J H,LI Y Z,HUANG X Y,et al.CT analysis of cavitary pulmonary aspergillosis second to obsolete pulmonary tuberculosis[J].Journal of Rare and Uncommon Diseases,2016,23(1):24-27.Chinese
[8]成向阳,何建行,杨运有,等.肺曲霉菌病外科治疗[J].中国胸心学血管外科临床杂志,2005,12(4):289-290.[8]CHENG X Y,HE J X,YANG Y Y,et al.Surgical treatment for pulmonary aspergillosis[J].Chinese Journal of Clinical Tuberacic Cardiovascular Surgery,2005,12(4):289-290.Chinese
[9]JUSON M A,STEVENS D A.The treatment of puimonary aspergilloma[J].Curr Opin Inverstig Durgs,2001,2(10):1375-1377.
[10]胡汶斌,袁顺达,俞幼林,等.结核性毁损肺微创治疗初步探讨[J].中国内镜杂志,2016,22(1):99-102.[10]HU W B,YUAN S D,YU Y L,et al.Preliminary discussion on minimally invasive treatment of tuberculosis-destroyed lung[J].China Journal of Endoscopy,2016,22(1):99-102.Chinese
[2]何嘉,陈野野,李单青.34例肺曲霉菌病的外科治疗[J].协和医学杂志,2013,14(3):318-322.[2]HE J,CHEN Y Y,LI S Q.Surgical treatment for pulmonary aspergillosis:report of 34 cases[J].Medical Journal of Peking Union Medical College Hospital,2013,14(3):318-322.Chinese
[3]蒋良双,吴邦贵,岳冀,等.肺结核病合并曲霉菌感染的诊断与外科治疗[J].中国胸心血管外科临床杂志,2013,20(3):312-316.[3]JIANG L S,WU B G,YUE J,et al.The diagnosis and surgical treatment of pulmonary tuberculosis complicated with aspergillus infection[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,2013,20(3):312-316.Chinese
[4]吴跃明,胡炜炜,冯江,等.肺曲霉菌病患者手术治疗的临床研究[J].中华医院感染杂志,2014,24(12):3008-3010.[4]WU Y M,HU W W,FENG J,et al.Clinical research for pulmonary aspergilloma patients with surgery[J].Chinese Journal of Nosocomiology,2014,24(12):3008-3010.Chinese
[5]韩俊垒,汤兵祥.陈旧性肺结核合并肺曲霉菌75例临床分析[J].河南医学研究,2011,20(1):76-78.[5]HAN J L,TANG B X.Clinical analysis of 75 cases of patients with old pulmonary tuberculosis combined with pulmonary aspergillosis[J].Henan Medical Research,2011,20(1):76-78.Chinese
[6]马丽,陈杭薇,李雪辉,等.肺曲霉菌病的临床研究进展[J].中华医院感染杂志,2016,26(16):3835-3837.[6]MA L,CHEN H W,LI X H,et al.Progress in clinical research of pulmonary aspergillosis[J].Chinese Journal of Nosocomiology,2016,26(16):3835-3837.Chinese
[7]梁建华,李远章,黄晓燕,等.陈旧性肺结核继发空洞性肺曲霉菌病CT分析[J].罕少见病杂志,2016,23(1):24-27.[7]LIANG J H,LI Y Z,HUANG X Y,et al.CT analysis of cavitary pulmonary aspergillosis second to obsolete pulmonary tuberculosis[J].Journal of Rare and Uncommon Diseases,2016,23(1):24-27.Chinese
[8]成向阳,何建行,杨运有,等.肺曲霉菌病外科治疗[J].中国胸心学血管外科临床杂志,2005,12(4):289-290.[8]CHENG X Y,HE J X,YANG Y Y,et al.Surgical treatment for pulmonary aspergillosis[J].Chinese Journal of Clinical Tuberacic Cardiovascular Surgery,2005,12(4):289-290.Chinese
[9]JUSON M A,STEVENS D A.The treatment of puimonary aspergilloma[J].Curr Opin Inverstig Durgs,2001,2(10):1375-1377.
[10]胡汶斌,袁顺达,俞幼林,等.结核性毁损肺微创治疗初步探讨[J].中国内镜杂志,2016,22(1):99-102.[10]HU W B,YUAN S D,YU Y L,et al.Preliminary discussion on minimally invasive treatment of tuberculosis-destroyed lung[J].China Journal of Endoscopy,2016,22(1):99-102.Chinese