肺结核空洞伴曲霉菌感染并咯血的外科治疗*

Surgical treatment for pulmonary tuberculosis cavity complicated with aspergillus infection and hemoptysis*

摘要:

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。

Abstract:

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 follow-up, 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.