205例肺结核合并支气管结核的外科治疗回顾分析

目的探讨肺结核合并支气管结核的外科治疗效果和手术适应症。方法总结1973年1月至2007年底手术切除的205例肺结核合并支气管结核的临床疗效。全组肺结核包括：原发综合征3例、浸润性肺结核19例、空洞性肺结核53例、慢性纤维空洞性肺结核45例、结核瘤或干酪性肺炎48例、结核性支气管狭窄27例、毁损肺10例。按照支气管结核分型,I型30例、Ⅱ型91例、川型50例、IV型34例。结果全肺切除术15例、全肺切除+胸廓成形术（胸改术）32例、肺叶切除术106例、肺叶切除术+胸改29例、支气管袖状成形术14例,其他手术9例。全组临床治愈率93.0%,手术并发症率为11.2%,手术死亡率为0.05%。结论虽然肺结核合并支气管结核是以抗结核药物为主要治疗方法,但目前仍有部分患者需要外科治疗。手术可提高肺结核合并支气管结核的临床治愈率。     

388例肺结核外科切除病例分析

目的探讨当前肺结核病的外科治疗效果和手术适应症。方法总结胸外科1999年1月～2007年12月手术切除的388例肺结核病的临床疗效。全组浸润肺结核116例,结核球或干酪性肺炎85例,慢性纤维空洞性肺结核66例,肺结核合并曲菌球形成18例,结核性支气管狭窄28例,结核性毁损肺75例。结果全肺切除术95例,肺叶切除术217例,气管或支气管成形术11例,其他手术65例。外科切除临床治愈372例治愈率95．9％,并发症33例发生率为8．5％,手术无死亡。结论虽然肺结核是以抗结核药物为主要治疗方法,但目前仍有部分患者需要外科治疗。外科手术可提高重症和耐多药肺结核的临床治愈率。     

电视辅助胸腔镜手术治疗胸部结核病变153例临床分析

目的总结电视辅助胸腔镜手术（VATS）治疗胸部结核病变的临床经验,以提高VATS治疗胸部结核病变的治愈率。方法2013年1月至2016年5月,广西壮族自治区龙潭医院胸外科对153例胸部结核患者根据手术的难易程度采用全电视胸腔镜手术（cVATS）技术或者电视胸腔镜辅助小切口（VAMT）技术进行治疗。153例患者中,肺结核47例,结核性脓胸100例,急性渗出性结核性心包炎6例;对本组患者采用的手术方式、患者的术后并发症及预后进行分析。结果术中无死亡患者。47例肺结核患者采用cVATS技术进行肺楔形切除术30例;采用VAMT技术进行肺叶切除术12例,肺段切除术5例。100例结核性脓胸患者,采用cVATS技术进行脓胸引流术2例,脓胸廓清术70例,胸膜纤维板剥脱术16例;采用VAMT技术进行胸膜纤维板剥脱术10例;2例中途转为常规切口。6例急性渗出性结核性心包炎患者均采用cVATS技术进行心包开窗术。7例（4．6％,7／153）患者术后1个月内出现并发症;其中急性左心功能衰竭1例,心肺复苏无效死亡;窦性心动过速1例,肺持续漏气〉7d3例,肺叶间裂积液2例,均经过相应处理后治愈。随访1～18个月,共计治愈130例（85．0％,130／153）,无效1例（0．7％,1／153）;22例仍处于随访中,痰菌均为阴性。结论VATS治疗无明显粘连、病变部位局限的肺结核,纤维素期与机化初期的结核性脓胸,有心包填塞症状的急性渗出性结核性心包炎,可以取得较好的疗效。     

耐多药肺结核188例的外科治疗

目的总结耐多药肺结核（MDR—PTB）的外科治疗经验。方法上海市肺科医院胸外科自1990年1月至2005年11月共行肺结核手术906例，其中MDR—PTB188例（20．8％），手术200例次，2次手术12例；肺叶切除85例次，肺叶切除并袖式及气管、支气管成形16例次，全肺切除48例次，余肺切除术3例次，支气管胸膜瘘（BPF）瘘管修补术5例次，胸廓成形并BPF修补22例次，脓胸剥脱并BPF修补6例次，开窗引流9例次，肋床引流5例次，右总支气管节段切除1例次。术前均行有效个体化抗结核治疗2—3个月。结果术中死亡率为0．5％（1／200）。术后1年内死亡率为3．2％（6／187），其中呼吸衰竭和心肌梗死各2例，肾衰竭和大咯血各1例。并发症率为13．9％（26／187），BPF11例，占并发症的42．3％（12／26）。所有患者术前痰菌均为阳性，术后阳性2例。随访时间6．7年（3个月至15年）。术后继续术前的抗结核方案治疗3—18个月。结论对持续痰菌阳性、病灶已局限的耐多药肺结核患者，应在有效抗结核治疗的基础上手术治疗。     

388例肺结核外科切除病例分析

目的探讨当前肺结核病的外科治疗效果和手术适应症。方法总结胸外科1999年1月—2007年12月手术切除的388例肺结核病的临床疗效。全组浸润肺结核116例,结核球或干酪性肺炎85例,慢性纤维空洞性肺结核66例,肺结核合并曲菌球形成18例,结核性支气管狭窄28例,结核性毁损肺75例。结果全肺切除术95例,肺叶切除术217例,气管或支气管成形术11例,其他手术65例。外科切除临床治愈372例治愈率95.9%,并发症33例发生率为8.5%,手术无死亡。结论虽然肺结核是以抗结核药物为主要治疗方法,但目前仍有部分患者需要外科治疗。外科手术可提高重症和耐多药肺结核的临床治愈率。     

支气管内膜结核的手术治疗

对75例支气管内膜结核分别实施袖状肺叶切除21例、全肺切除10例、肺叶切除42例、支气管楔形切除2例。无手术死亡者,术后无残端瘘或狭窄者,吻合口漏1例;痰结核菌全部转阴。认为支气管内膜结核造成支气管狭窄时应及时行手术治疗;肺叶切除是常规术式,袖状肺叶切除术是最佳术式;预防支气管吻合口及残端狭窄是手术的关键。     

手术联合化疗治疗耐多药肺结核结果分析

目的临床上耐多药肺结核患者治疗效果往往不佳。探讨手术联合化疗治疗耐多药肺结核患者的疗效。方法对自1995年4月至2005年3月住院的48例采用外科手术治疗＋化疗的耐多药肺结核患者进行分析。肺部有空洞病变36例（75％），双侧肺均有病变16例（33．3％）。手术方式包括肺叶切除28例，全肺切除15例，胸膜全肺切除3例，肺段切除1例，楔形切除1例。结果术后死亡率2．1％（n=1）。并发症发生率16．7％（n=8）。术后随访6～90月。痰菌阴转率83．3％。结论耐多药肺结核患者若有良好的心肺功能储备，手术治疗安全有效，配合化疗能提高患者的治愈率。     

112例结核性脓胸的外科治疗分析

目的探讨结核性脓胸的外科治疗效果和手术适应症。方法总结北京胸科医院1999年1月～2008年底手术切除的112例结核性脓胸的临床疗效。全组包括：结核性全脓胸49例、肺结核合并结核性全脓胸1例、结核性包裹性脓胸53例、肺结核合并结核性包裹性脓胸3例、结核性脓胸合并支气管胸膜瘘6例。结果胸膜纤维板剥脱术67例、胸膜全肺切除术10例、胸膜肺叶切除术4例、胸膜肺部分切除术6例、胸膜纤维板剥脱＋胸廓成形术18例,其他手术7例。总治愈率95．0％,手术并发症率12．5％,死亡率0．9％。结论患者一旦发展成慢性结核性脓胸应及早外科治疗,手术是治疗慢性结核性脓胸的唯一有效方法。     

肺结核患者采用不同电视辅助胸腔镜术式的临床及疗效分析

目的对肺结核患者采用不同电视辅助胸腔镜手术（video-assisted thoracoscopic surgery,VATS）术式的临床及疗效进行客观分析。方法回顾分析新疆维吾尔自治区胸科医院胸外中心2009年9月至2016年2月实施VATS治疗的299例肺结核患者的临床资料。其中,134例行肺叶、肺段或全肺切除术（简称“A组”）,A组患者均确诊肺结核,111例经6个月以上规范抗结核药物治疗后,效果不佳,病灶局限单侧一肺叶内,23例大咯血患者经过药物及栓塞治疗无法止血;96例行肺部分切除术（简称“B组”）,B组患者中82例为术前临床影像学诊断为肺结核球患者,结核球直径〉2．5cm、〈5cm,经过规范药物治疗6个月以上后,疗效不佳,14例术前疑似肺部肿瘤;69例行胸膜剥脱术（简称“C组”）,均诊断为结核性胸膜炎,置管引流失败或无法置管引流,胸部CT扫描提示胸膜增厚,形成包裹性胸膜炎。结果299例实施VATS的患者中,A组手术平均时间（175．6±63．8）min,术中平均出血量（415．9±515．7）ml,中转开胸12例（9．0％,12／134）,术后平均胸管留置时间（3．2±1．5）d,发生并发症10例（7．5014,10／134）。B组患者手术平均时间（78．6±40．8）min,平均出血量（62．5±107．2）ml,中转开胸2例（2．1％,2／96）,术后平均胸管留置时间（3．3±1．5）d,发生并发症3例（3．1％,3／96）。C组患者手术平均时间（103．0±53．4）min,平均出血量（169．5±174．2）ml,中转开胸4例（5．8％,4／69）,术后平均胸管留置时间（3．0±0．8）d。3组患者平均随访20个月,A组中远期并发症有1例,是大咯血患者急诊行肺叶切除术,术后1个月出现结核播散,并发现耐药感染,根据药物敏感性试验结果调整治疗2个月后病灶吸收,B组与C组无远期并发症发生。结论对于符合上述不同手术方式适应证的肺结核患者,VATS治疗是安全、可行并且疗效肯定的选择。     

胸腔镜手术治疗支气管扩张症

目的探讨胸腔镜手术在支气管扩张症中的应用价值。方法2002年7月～2010年3月,对20例支气管扩张症行胸腔镜手术治疗。12例施行胸腔镜辅助小切口肺叶切除术,8例施行胸腔镜肺楔形切除术。结果1例因出血中转开胸。全组无围手术期死亡,围手术期并发症3例：术后肺持续漏气2例,肺部感染1例。平均胸管置管时间3．6d（2～7d）,术后住院平均9d（7～14d）。20例随访3～36个月,均恢复良好。结论胸腔镜手术治疗支气管扩张症在技术上是安全可行的,对于具有手术指征需行肺楔形切除或肺叶切除的支气管扩张症患者,胸腔镜手术是一种值得推荐的手术方式。     

The role of surgery in cases of diagnostic difficulty]

Pulmonary resections for the treatment of pulmonary tuberculosis are decreasing, and nowadays most of them are for the open lung biopsy to make histological diagnosis, because differentiation between tuberculosis, AM and lung cancer is critical. In 1980-1990 forty-three patients, in whom the diagnosis was not established by conventional diagnostic methods, had pulmonary resections for open lung biopsy because of abnormal chest X-ray shadows. Of these, 31 (72%) were non-tuberculous (lung cancer 8, hamartoma 7, lung abscess 5, fungus infection 3, sclerosing hemangioma 2, bronchogenic cyst 2, and others 4, and 12 (28%) were tuberculous or AM. The type of chest film abnormality was solitary pulmonary nodule (coin lesion) in 9 out of 12 patients with tuberculosis or AM, in all eight patients with lung cancer and in 14 out of 23 patients with other diseases. In patients with coin lesions, the incidence of lung cancer was as high as 50% when the diameter was more than 21mm, while it was only 11% when it was 20mm or less. 24 patients with tuberculosis or AM complicated by lung cancer or other diseases were resected. There were 8 smear or culture positive patients with active pulmonary tuberculosis (or AM) (Group 1), of whom 7 had lung cancer and 1 pneumothorax. Of 8 patients who were wrongly diagnosed as active pulmonary tuberculosis (Group 2), there were 5 lung cancers and 3 other diseases. In the remaining 8 patients (Group 3) both old tuberculosis and lung cancer coexisted and in 3 they were found in the same lobe.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lung resection in drug resistant tuberculosis patients

Three and seventy-one case histories of patients operated on for different forms of pulmonary tuberculosis in whom their Mycobacteria tuberculosis (MT) were resistant to bactericidal drugs (BD) were analysed. Fibrocavenous or cavernous pulmonary tuberculosis was detected in most patients (73.3%). Various postoperative complications occurred in 20% of the patients operated on, in them empyema with bronchial fistula was stated in 6.5% of cases. The immediate outcomes of lung resections were satisfactory in 90% of patients and poor (progressive tuberculosis, uncorrected empyema) in 6%, mortality was 4%. Comparing these data with the outcomes of 6033 resections whose efficiency was 96.4% and mortality 1.4% leads to the conclusion that MT resistance to BD negatively affect the outcomes of resections.     

Results of surgical treatment of 107 patients with complications of pulmonary tuberculosis

Abstract The objective of this study was to evaluate the results of surgical intervention performed on 107 patients with pulmonary tuberculosis complications. Between September 1988 and December 1995, 107 patients underwent a total of 126 operations for major complications of pulmonary tuberculosis. One hundred and twenty-six operations consisted of lobectomies only or plus other lung resections performed in 55 cases, pneumonectomies in 20 cases, segmentectomies in 18 cases, wedge resections in two cases, tracheobronchoplasties in four cases, decortications in two cases, cavernostomies with concomitant muscle transpositions in seven cases, thoracoplasties reserved for the previously failed operations or to be a supplement for pulmonary resections in 18 cases. The operative mortality rate was of 1.8%, and the major complication rate was of 16.8%. Twenty-eight (26.1%) patients with tuberculosis bacilli in sputum before operation have converted except one diabetic patient. In conclusion, surgery is indicated in pulmonary tuberculosis complications that are life-threatening or unresponsive to chemotherapy. Pulmonary resection is the procedure of choice for most cases that require surgery.     

Mechanical properties of the lungs and capillary blood flow in patients with cavernous tuberculosis before and after partial resection]

The results of the study of pulmonary ventilation function, respiratory biomechanics and capillary blood flow in 16 patients with cavernous tuberculosis before and after partial resections are given. An obstructive component due to the inflammatory changes in the bronchial tree was found to underlie moderate impairments in pulmonary mechanical properties. The capillary blood flow depends on the magnitude of secondary changes in lung tissue. Partial resections lead to deterioration of elastic properties of the lungs in combination with reduced capillary network. Recovered functional parameters in the long-term period of the follow-up confirms that it is expedient to use partial resection in the early stage of a combined treatment of patients with cavernous pulmonary tuberculosis.     

Lungenresektionen bei nicht lappenbegrenzten Tuberkulosen

This is a report on early and late results (five years postoperative) of lung resections, carried out between 1955 and 1964, in pulmonary tuberculosis not confined to one lobe. The cases under review concerned patients suffering either from chronic relapses of tuberculosis or progressive aggravation of tuberculosis due to failure of the primary conservative therapy. In these cases, the resections affecting more than one lobe, without drastically interfering with lung function, succeeded in the rehabilitation (restoration of fitness to work) of 86% and in the permanent decontamination of 91%. The rate of early mortality was 3.7%. Late controls showed a loss, in most cases, of less than 20% of the initial vital capacity. It is true that bronchus fistulae appeared twice as often as with conventional resections made for treating tuberculosis during the same period. However, it was possible to remove most of the fistulae by secondary operation. In conclusion, in cases of tuberculosis which has seized several lobes, resection is recommended.     

肺结核合并肺癌156例临床分析

目的 分析肺结核合并肺癌患者的临床特点,以便早期识别肺结核合并肺癌患者。 方法 对我院2000年1月至2011年12月确诊的156例肺结核合并肺癌患者的临床表现、肺癌病灶与肺结核病灶的关系、确诊时间、病理类型、确诊方法进行回顾性分析。 结果 肺结核合并肺癌患者以痰中带血为其常见的临床特征,CT影像以双肺上叶结节多见,部分病灶呈团块样病变;肺结核与肺癌病灶在同侧同叶19例（12.2%,19/156）,病灶肺叶不同侧72例（46.2%,72/156）,病灶肺叶部分重叠65例（41.7%,65/156）;已知有肺结核病史后诊断肺癌者67例（42.9%,67/156）,已知有肺癌病史后诊断肺结核者6例（3.8%,6/156）,2种病同时诊断者83例（53.2%,83/156）,平均确诊时间从11.4个月到12.5年不等;病理类型以非小细胞肺癌为主,均通过痰查癌细胞和纤维支气管镜刷检找癌细胞获得明确诊断。 结论 肺结核合并肺癌患者具有一定的临床特点和CT影像特征,应及早明确诊断,对2种病进行早期同时治疗,以便获得较好的疗效。     

Active pulmonary tuberculosis in patients with lung cancer

To clarify the features of the coexistence of active pulmonary tuberculosis in patients with lung cancer, we analyzed clinical data on 25 cases with coexisting lung cancer and active pulmonary tuberculosis encountered at Tokyo National Chest Hospital during the period from 1991 to 1998. There were 23 men and 2 women, with a mean age of 70 years. The incidence of lung cancer among patients with active pulmonary tuberculosis at our hospital was 0.7 per cent, while the incidence of active pulmonary tuberculosis in untreated lung cancer patients at our hospital was 1.9 per cent. We classified the 25 cases into 2 groups as follows: (1) tuberculosis sequential to lung cancer (11 cases) and (2) tuberculosis concurrently detected with lung cancer (14 cases). All patients in the former group were transferred from other hospitals after diagnosing the coexistence of pulmonary tuberculosis during the management of lung cancer. Histological types of lung cancer were squamous cell carcinoma in 12, adenocarcinoma in 9, and small cell carcinoma in 4, and as to the disease stage, stages III to IV were predominant. Analysis on relationship of chest X-ray findings between lung cancer and pulmonary tuberculosis revealed that in general, the location of lung cancer and tuberculosis seemed to be independent. Tuberculosis in the sequential group was more extensive and severer than in the concurrent group. In the concurrent group, treatment for tuberculosis was successful except for one case, and coexisting tuberculosis did not seem to affect the course of lung cancer among this group. However, in the sequential group, 5 patients died within 3 months, 2 of them died of tuberculosis. We consider that in the management of lung cancer, physicians should consider the possibility of coexistent active pulmonary tuberculosis and should not make delay in the diagnosis of active pulmonary tuberculosis.     

Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. Clinical study on pulmonary tuberculosis associated with lung cancer patients

Sixteen of 758 lung cancer in patients (2.1%) were found to have coexisting pulmonary tuberculosis. Of the above 16 of 758 patients (fifteen men and one woman), 4 of 214 patients (1.9%) were found from 1988 to 1989, and 12 of 544 patients (2.2%) from 1991 to 1994. In six patients, pulmonary tuberculosis and lung cancer were found at the same time by clinical work up. In five cases each, pulmonary tuberculosis preceded lung cancer, and lung cancer preceded pulmonary tuberculosis, respectively. Ten patients had adenocarcinoma, 4 had squamous cell carcinoma, and one each had large cell carcinoma and small cell carcinoma, respectively. Five patients were in stage "II", one in "IIIa", two in "IIIb", and eight in "IV" of clinical stage of lung cancer. As regards extent of pulmonary tuberculosis, one patient was in category "II" of the classification of the Japanese Society for Tuberculosis, 13 were in "III", and two were in "IV". Among 544 lung cancer patients from 1991 to 1994, 9 of 151 patients (6.0%) with a past history of pulmonary tuberculosis, had active pulmonary tuberculosis, and 3 of 393 patients (0.8%) with no history of pulmonary tuberculosis, had active pulmonary tuberculosis (statistically significant; p < 0.005). Five smear-positive patients were transferred to a tuberculosis hospital or a tuberculosis ward, and the remaining 11 patients were treated in isolation in the ward where they were. The efficacy of anti-tuberculous chemotherapy was almost comparable to that in patients without lung cancer. However, prognosis was poor, in line with that of lung cancer. Main discussion was devoted to the reason why the incidence (in association with tuberculosis) of adenocarcinoma exceeded that of squamous cell carcinoma in our present study at variance with the studies of other investigators.     

A new parameter in the detection of tuberculosis activity: reactive oxygen metabolites

BACKGROUND AND OBJECTIVES: In countries with a high frequency of tuberculosis, there are problems not only with active lung tuberculosis but also with past lung tuberculosis. Cases with sequel tuberculosis very frequently present with complaints like tuberculosis, and it is very hard to determine whether it is a sequel tuberculosis complication or reactivation of tuberculosis. In this study, we measured the serum reactive oxygen metabolite (ROM) levels of patients with active pulmonary tuberculosis and healthy controls, and investigated if these metabolites can be used as a criterion for differentiation between active pulmonary tuberculosis and sequel pulmonary tuberculosis. METHODS: 40 patients with active tuberculosis, 35 patients with sequel pulmonary tuberculosis and 30 healthy control subjects with a similar age range and sex distribution were included in the study. Serum total ROM levels were detected in the patients and control group. RESULTS: Mean serum ROM values were 994+/-236, 551+/-135 and 236+/-59 U/l among active lung tuberculosis cases, sequel lung tuberculosis cases and the healthy control group, respectively. As a result of these findings, serum ROM levels of active lung tuberculosis cases and sequel lung tuberculosis cases were significantly higher than those of the control group (both p<0.001). The serum ROM levels of active lung tuberculosis cases were also significantly higher than those of sequel lung tuberculosis cases (p<0.001). CONCLUSIONS: In the light of our findings, it may be assumed that serum total ROM values can be used as an activity criterion in the differentiation of active lung tuberculosis and sequel lung tuberculosis.     

76例肺癌合并肺结核临床特点分析

目的探讨肺癌合并肺结核的临床特点。方法回顾性分析76例肺癌同时或序贯合并肺结核患者的临床资料。结果肺癌合并肺结核的男女之比为2.3∶1,中位年龄为52岁。临床表现主要为咳嗽咳痰、胸闷气促、发热;中心型和周围型肺癌分别占42.1%（32例）和43.4%（33例）,28例（36.8%）伴有胸腔积液;确诊为肺癌到确诊肺结核的中位时间为3.4个月。肺结核以浸润型为主,占64.5%（49例）;肺癌以鳞癌和腺癌为主,Ⅲ期肺癌占48例（55.3%）,Ⅳ期18例（23.7%）。结论肺癌合并肺结核以中年男性为主,肺癌的临床表现、影像学表现、病理类型、临床分期和肺结核的类型无特异性。