Abstract:

Objective To analyze the effect of surgical treatment on the patients with multi-drug resistant pulmonary tuberculosis. Methods  A retrospective analysis of the clinical data and follow-up Results were performed on a total of 42 patients with multi-drug resistant pulmonary of tuberculosis in our hospital from January 2009 to June 2016. These 42 patients underwent different surgery procedures, included single lobectomy in 17 cases, multiple lobectomy in 15 cases, Pneumonectomy in 5 cases, completion pneumonectomy in 2 cases and segmentectomy in 2 cases. Results  One patient with single lobectomy and one patient with segmentectomy were lost after one month of follow-up. And 40 patients were followed up for one to 84 months （26 ± 24.8 months）. For the rest 40 patients, the treatment success rate, remission rate, failure rate were 80.0%（32/40）, 7.5%（3/40）, 12.5%（5/40, including 3 death patients）respectively. They were 16/16, 0 respectively in single lobectomy patients ; 11/15, 2/15, 2/15 respectively in multiple lobectomy patients; 3/5, 1/5, 1/5 respectively in pneumonectomy patients; 2/3, 0, 1/3 respectively in completion pneumonectomy patients; 1/1, 0, 0 respectively in segmentectomy patients. The incidence of complication was 35.0%（14/40）. The complications included intractable cavity（12.5%, 5/40）, bronchopleural fistula（12.5%, 5/40）, pleural infection（5.0%, 2/40）, pleural active bleeding（2.5%, 1/40）and incision infection（2.5%, 1/40）. The complication proportions in the five surgical procedures were 2/16, 8/15, 2/5, 2/3, 0 respectively. Conclusion Surgery is helpful to improve the treatment success rate for patients with multi-drug resistant pulmonary tuberculosis. Single lobectomy should be the preferred surgical procedure for the single lobe lesions. For the multiple lobectomy, surgical complications should be prevented.

Key words: pulmonary, drug-resistant, lobectomy, tuberculosis, surgery, pneumectomy, mycobacterium tuberculosis

摘要：

目的 分析耐多药肺结核的手术治疗效果。方法 回顾性分析我院2009年1月至2016年6月行单肺叶切除术17例、复合肺叶切除术15例、全肺切除术5例、余肺切除术3例、肺段切除术2例等共计42例耐多药肺结核肺切除术患者的临床资料和随访结果 。结果 42例患者随访1～84月（26±24.8月），单肺叶切除术、肺段切除术各1例患者随访1月后丢失。40例随访资料完整的患者的治疗成功率、病情缓解率、失败率分别为80.0%（32/40）、7.5%（3/40）、12.5%（5/40，其中3例死亡），其中：单肺叶切除术分别为16/16、0、0，复合肺叶切除术分别为11/15、2/15、2/15，全肺切除术分别为3/5、1/5、1/5，余肺切除术分别为2/3、0、1/3，肺段切除术分别为1/1、0、0；手术并发症发生率35.0%（14/40），包括顽固性空腔（12.5%，5/40）、支气管胸膜瘘（12.5%，5/40），胸腔感染（5.0%，2/40），胸腔内出血（2.5%，1/40）和伤口感染（2.5%，1/40），5种手术方式的并发症发生比例分别为2/16、8/15、2/5、2/3、0。结论 手术治疗有助于提高耐多药肺结核患者的治疗成功率，对于单肺叶内局限性病灶患者，建议首选单肺叶切除术；对于多肺叶切除的手术，则应积极防范手术并发症。

关键词: 结核, 外科手术, 结核杆菌, 肺切除术, 药物耐受性, 肺, 叶切除术