PDF(Pubmed)
Abstract：
UNASSIGNED: The World Health Organization guidelines for management drug resistant tuberculosis include surgery as an additional method in selected cases. Pneumonectomies have higher risk of morbidity such as bronchial fistulas which may be prevented by bronchial stump covering. We compare two methods of bronchial stump reinforcement.
UNASSIGNED: A retrospective single center follow-up study was done in 52 patients who underwent pneumonectomy for drug resistant pulmonary tuberculosis. Between 2000 and 2017 we performed pneumonectomies with pericardial fat reinforcement of bronchial stump in group 1 (n = 42), and between 2017 and 2021 in group 2 with pedicled muscle flap reinforcement group 2 (n = 10).
UNASSIGNED: Bronchial fistulas occurred in 17/42 (41%) of patients group 1 and there was no fistula in group 2, and this was statistically different (Fisher\'s test p = 0.02). Post-operative complications were seen in 24/42 (57%) of the patients in Group 1, and 4/10 (40%) patients in Group 2 (Fischer\'s test p = 0.53). In group 1 positive bacteriology decreased from 74% to 24% just after surgery, and in group 2 it decreased from 90% to 10%, but this was not statistically different (Fisher\'s test p = 0.63). In group 1 no-one died the first month, but 8/42 (19%) died within a year; in group 2 one died within a month, and only this death (10%) within a year. This difference in case fatality was not statistically significant.
UNASSIGNED: The use of pedicle muscle flap for bronchial stump coverage during the pneumonectomies for destructive drug resistant tuberculosis can prevent severe postoperative fistulas and improve postoperative life.
UNASSIGNED: A retrospective single center follow-up study was done in 52 patients who underwent pneumonectomy for drug resistant pulmonary tuberculosis. Between 2000 and 2017 we performed pneumonectomies with pericardial fat reinforcement of bronchial stump in group 1 (n = 42), and between 2017 and 2021 in group 2 with pedicled muscle flap reinforcement group 2 (n = 10).
UNASSIGNED: Bronchial fistulas occurred in 17/42 (41%) of patients group 1 and there was no fistula in group 2, and this was statistically different (Fisher\'s test p = 0.02). Post-operative complications were seen in 24/42 (57%) of the patients in Group 1, and 4/10 (40%) patients in Group 2 (Fischer\'s test p = 0.53). In group 1 positive bacteriology decreased from 74% to 24% just after surgery, and in group 2 it decreased from 90% to 10%, but this was not statistically different (Fisher\'s test p = 0.63). In group 1 no-one died the first month, but 8/42 (19%) died within a year; in group 2 one died within a month, and only this death (10%) within a year. This difference in case fatality was not statistically significant.
UNASSIGNED: The use of pedicle muscle flap for bronchial stump coverage during the pneumonectomies for destructive drug resistant tuberculosis can prevent severe postoperative fistulas and improve postoperative life.
摘要：
■世界卫生组织关于耐药结核病的管理指南将手术作为选定病例的附加方法。肺切除术具有较高的发病风险，例如支气管瘘，可以通过支气管残端覆盖来预防。我们比较了两种支气管残端加固方法。
■对52例因耐药肺结核行全肺切除术的患者进行了回顾性单中心随访研究。在2000年至2017年之间，我们在第1组（n=42）中进行了支气管残端心包脂肪强化的肺切除术，在2017年至2021年之间，第2组使用带蒂肌瓣加固第2组（n=10）。
■第1组患者中有17/42例（41%）发生支气管瘘，第2组患者没有发生支气管瘘，这在统计学上有差异（Fisher检验p=0.02）。术后并发症见于第1组24/42(57%)患者和第2组4/10(40%)患者(Fischer检验p=0.53)。在第1组中，术后阳性细菌学从74％下降到24％，在第2组中，它从90%下降到10%，但这在统计学上没有差异(Fisher检验p=0.63)。在第一组中，没有人在第一个月死亡，但是8/42（19％）在一年内死亡；在第2组中，1个月内死亡，一年内只有这种死亡（10％）。病死率的这种差异没有统计学意义。
■在全肺切除术中使用带蒂肌瓣覆盖支气管残端治疗破坏性耐药结核病，可以预防严重的术后瘘并改善术后生活。
■对52例因耐药肺结核行全肺切除术的患者进行了回顾性单中心随访研究。在2000年至2017年之间，我们在第1组（n=42）中进行了支气管残端心包脂肪强化的肺切除术，在2017年至2021年之间，第2组使用带蒂肌瓣加固第2组（n=10）。
■第1组患者中有17/42例（41%）发生支气管瘘，第2组患者没有发生支气管瘘，这在统计学上有差异（Fisher检验p=0.02）。术后并发症见于第1组24/42(57%)患者和第2组4/10(40%)患者(Fischer检验p=0.53)。在第1组中，术后阳性细菌学从74％下降到24％，在第2组中，它从90%下降到10%，但这在统计学上没有差异(Fisher检验p=0.63)。在第一组中，没有人在第一个月死亡，但是8/42（19％）在一年内死亡；在第2组中，1个月内死亡，一年内只有这种死亡（10％）。病死率的这种差异没有统计学意义。
■在全肺切除术中使用带蒂肌瓣覆盖支气管残端治疗破坏性耐药结核病，可以预防严重的术后瘘并改善术后生活。
