摘要
目的总结应用带蒂肋间肌瓣治疗肺结核术后支气管胸膜瘘的经验。方法回顾性分析2005年1月-2016年12月采用手术修补加带蒂肋间肌加固填塞治疗的14例支气管胸膜瘘患者资料,男性8例,女性6例,年龄(44±7. 5)岁。10例为肺结核肺切除术后支气管胸膜瘘,4例结核性脓胸纤维板剥脱术后支气管胸膜瘘。手术前均经有效方案抗结核治疗,结核控制稳定,胸腔感染控制稳定。术后有效方案抗结核治疗18-24月,随访3年。结果无围手术期死亡,手术时间(134±23. 4)分,术中出血(455±45. 8) m L。术后随诊最长3年,最短18个月,无支气管胸膜瘘复发,1例患者因抗结核治疗效果不佳脓胸复发,长期置管冲洗引流,治愈。结论带蒂肋间肌瓣用于治疗结核性支气管胸膜瘘安全有效,术前术后应全程规范有效抗结核治疗。
Objective To summarize the experience of the treatment of postoperative bronchopleural fistula in patients with pulmonary tuberculosis by pedicled intercostal muscle flap. Methods 14 cases with postoperative bronchopleural fistula were underwent repair and bronchial stump reinforcement with the intercostal muscle flap from January 2005 to December 2016. There were 8 males and 6 females with average age of （44±7.5） years old. 10 cases bronchopleural fistula occurred after pulmonary section and 4 after fibreboard decortication. The procedures were performed while the thoracic infection was controlled by the treatment with appropriately antituberculosis and antibacterial regimen. According the drug resistance spectrum, 18-24 months of anti-TB regimen was carried out and the patients were followed-up for 3 years after the operations. Results There was no perioperative death. The average operation time was （134±23.4） minutes, and the intraoperative bleeding was （455±45.8） mL. The postoperative follow-up duration ranged from 18 to 36 months. Empyema recurred in 1 patient with multi-drug resistant tuberculosis and no recurrent pleural fistula. This patient was cured with long-term thoracic irrigating and drainage. Conclusion Pedicled intercostal muscle flap in treatment of tuberculous bronchial fistula is safe and effective. The appropriate anti-tuberculous remedy should be carried out before and after the operation.
作者
韦林
刘玉钢
丁超
谷振宁
朱昌生
WEI Lin;LIU Yu-gang;DING Chao;GU Zhen-ning;ZHU Chang-sheng(Xi＇an Chest Hospital,Xi＇an,Shaanxi 710100,China)
出处
《临床肺科杂志》
2018年第12期2273-2276,共4页
Journal of Clinical Pulmonary Medicine
关键词
肺结核
支气管胸膜瘘
治疗
手术
pulmonary tuberculosis
bronchopleural fistula
treatment
surgery
