外科治疗非结核分枝杆菌肺病的临床疗效分析

目的探讨外科手术治疗非结核分枝杆菌(NTM)肺病的疗效及时机,为优化非结核分枝杆菌(NTM)肺病治疗方案提供循证医学依据。方法以数字表法随机选取武汉市医疗救治中心胸外科2008年10月至2014年3月确诊的NTM肺病患者85例,其中观察组42例[男性28例,女性14例,年龄(36.6±1.0)岁]给予手术治疗,术后根据药敏结果用药治疗12个月以上;对照组43例[男性29例,女性14例,年龄(33.4±1.5)岁],根据药敏结果用药治疗18个月以上;随访24个月,观察对比两组患者治愈率、病情无变化例数(率)、病情逆转率、死亡率,并对观察组组不同病程患者的治愈率和并发症发生率进行比较。结果对照组治愈率、死亡率分别为41.9%(18/43)、16.3%(7/43);观察组治愈率、死亡率分别为83.3%(35/42)、2.4%(1/42),观察组治愈率远高于对照组,而死亡率明显低于对照组,比较两组有统计学意义(P0.01));观察组病情逆转率分别为4.8%(2/42)亦低于对照组的18.6%(8/43),P0.05。观察组不同病程分组比较并发症及治愈率,病程3年内明显优于3-6年及6年以上(P0.01);病程3-6年优于6年以上(P0.05)。结论对确诊NTM肺病,经药物治疗6个月以上,治疗效果不理想且病变局限的患者,可考虑手术切除病肺,早期手术治疗效果优于晚期手术治疗。

Clinical effect analysis of surgical treatment for non-tuberculosis mycobacteria pulmonary disease

Objective To study the outcome and preferable timing of surgical treatment for non-tuberculosis mycobacteria ( NTM) pulmonary disease and to provide evidence-based medical evidence for optimized surgical treat-ment on NTM pulmonary disease. Methods 85 cases with NTM lung disease were selected from October, 2008 to March, 2014 in Wuhan Medical Cure Center, including the observation group [28 males and 14 females, age (36. 6 ± 1. 0)] for surgical treatment and the control group [29 males and 14 females, age (33. 4 ± 1. 5)]. According to the results of drug sensitive test, the observation group was given drug treatment more than 12 months, and the con-trol group for more than 18 months. All of them were followed-up for 24 months. Their curative rate, reversal rate and mortality were observed and compared. Results The curative rate was 41. 9% ( 18/43 ) in the control group and 83. 3% (35/42) in the observation group. The mortality was 2. 4%(1/42) in the observation group and 16. 3% (7/43) in the control group. The illness exacerbation rate was 4. 8% (2/42) in the observation group and 18. 6% in the control group (8/43). Compared with the complications and the curative rate in the observation group, their illness duration less than 3 years were significant better than that over 3 years. Conclusion For those patients with NTM lung disease received more than 6-month drug treatment without significant effect, the surgical treatment should be considered, and the curative effect is better as soon as possible.