结核毁损肺切除术后支气管胸膜瘘32例临床分析.docVIP

结核毁损肺切除术后支气管胸膜瘘32例临床分析 　　作者：叶峥嵘,易云峰,陈亮,陈检明,焦昌结　　作者单位：福建漳州，解放军第175医院 厦门大学附属东南医院心胸外科 　　【摘要】 目的 探讨结核毁损肺切除术后支气管胸膜瘘的特点和诊治经验。方法 对1996年5月-2008年5月32例结核毁损肺切除术后支气管胸膜瘘患者的临床资料进行回顾性分析。结果 11例保守治疗者痊愈7例，死亡4例;6例纤支镜、胸腔镜纤维蛋白胶封堵者痊愈4例， 2例再次发生支气管胸膜瘘;手术治疗11例中7例痊愈，2例再次发生支气管胸膜瘘，2例死亡;4例行金属支架置入堵瘘术痊愈4例。32例中共死亡6例(18.75%)。结论 支气管胸膜瘘重在预防，治疗的关键在于封闭瘘口，彻底消灭脓腔。 　　【关键词】 结核性,毁损肺,肺切除,支气管胸膜瘘,分析 　　【Abstract】 Objective To explore the experience of the therapy on the patients with bronchopleural fistula after pneumonectomy of the destroyed lung by pulmonary tuberculosis.Methods Explored the destruction of pulmonary tuberculosis bronchial pleural fistula after resection,the characteristics and treatment experiences of 32 cases of tuberculosis damaged bronchopleural fistula after lung resection were retrospectively analyzed in clinical data from May 1996 to May 2008.Results The eleven cases of brazing branch mirror treatment were cured in seven cases ,four deaths;in the six cases of brazing branch mirror,mirror chest fibrin glue sealing recovered in four cases,the two cases were recurrence of bronchial fistula;The surgical treatment of 11 cases which are recovered for seven cases;Two cases were recurrence of bronchial pleural fistula,two cases death.The four routine metal stent implantation in blocking fistula surgery recoveried;The 32 cases of person which are died in six(18.75%).Conclusion Bronchial pleural fistula focuses on prevention;the treatment of which is key to fistula closure and to eliminate vomica. 　　【Key words】 pulmonary tuberculosis;destroyed lung;bronchopleural fistula;pneumonectomy;treatment outcome 　　近年来，虽然肺切除手术技术有了很大的改进和提高，但支气管胸膜瘘(bronchopleuralfistula,BPF)仍是肺切除术后、特别是结核毁损肺切除术后常见的严重并发症， 一旦发生将严重危及病人生命，病死率为23.6%～71.2%[1，2]。本文对我科1996年1月-2008年5月收治的32例结核性毁损肺切除术后支气管胸膜瘘患者的临床资料进行回顾性分析，现报告如下。 　　1 资料与方法 　　1.1 临床资料 本组32例支气管胸膜瘘患者，男20例，女12例，年龄23～75岁，平均47.8岁;其中体型消瘦28例，合并糖尿病10例，左全肺切除22例，右全肺切除9例，右上肺叶切除1例; 32例病人术后标本病理均证实诊断为结核性毁损肺。32例中5例于术后2周内发生支气管胸膜瘘(15.63%)，27例于术后2周～6个月内发生支气管胸膜瘘(