Tseng Y L, Wu M H, Lin M Y, Lai W W
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No 138, Sheng-Li Road, Tainan, Taiwan.
Eur J Cardiothorac Surg. 2000 Dec;18(6):666-70. doi: 10.1016/s1010-7940(00)00594-7.
Conventionally, pulmonary resection with thoracoplasty is used to treat fibrocavernous complication of pulmonary tuberculosis. This operation is usually bloody, time-consuming with complicated postoperative course. To prevent massive blood loss and preserved pulmonary function, a more simplified operative procedure, cavernostomy combined intrathoracic muscle flap transposition was used and the outcome was evaluated in this study.
Retrospective review.
Between December 1989 and June 1996, a total of ten patients with fibrocavernous pulmonary tuberculosis were managed using cavernostomy combined with intrathoracic muscle flap transposition. Five of them had concomitant aspergilloma within the cavity while three had multiple drug resistant pulmonary tuberculosis. The muscle flap was used to plombage the cavity and reinforce the closure of bronchopleural fistula after cavernostomy.
Six postoperative complications occurred in five patients, including reformation of cavity (2), bronchopleurocutaneous fistulae (3), and postoperative bleeding (1). The success or failure of intrathoracic muscle flap transposition on patients with fibrocavernous tuberculosis was significantly correlated with the size of the cavity (194.0+/-11.2 vs. 283.0+/-44.6 cm(3), P=0.016) and the number of bronchopleural fistulae (1.6+/-0.4 vs. 4.0+/-0.4, P=0.008). There was no operative death and in long term follow-up, there was no recurrence of hemoptysis or deterioration of pulmonary function in the successful group of patients.
Cavernostomy combined with intrathoracic muscle flap transposition can be used to treat well-selected fibrocavernous pulmonary tuberculosis patients, except on patients with large size cavity, multiple bronchopleural fistulae or multiple drug resistance tuberculosis.
传统上，肺切除加胸廓成形术用于治疗肺结核纤维空洞并发症。该手术通常出血多、耗时且术后病程复杂。为防止大量失血并保留肺功能，本研究采用了一种更简化的手术方法，即空洞造口术联合胸内肌瓣移位术，并对其结果进行了评估。
回顾性研究。
1989年12月至1996年6月期间，共有10例纤维空洞型肺结核患者接受了空洞造口术联合胸内肌瓣移位术治疗。其中5例患者空洞内合并曲霉菌球，3例为耐多药肺结核。肌瓣用于填充空洞并在空洞造口术后加强支气管胸膜瘘的闭合。
5例患者出现6例术后并发症，包括空洞复发（2例）、支气管胸膜皮肤瘘（3例）和术后出血（1例）。胸内肌瓣移位术治疗纤维空洞型肺结核患者的成功与否与空洞大小（194.0±11.2 vs. 283.0±44.6 cm³，P = 0.016）和支气管胸膜瘘数量（1.6±0.4 vs. 4.0±0.4，P = 0.008）显著相关。无手术死亡病例，在长期随访中，成功组患者无咯血复发或肺功能恶化。
空洞造口术联合胸内肌瓣移位术可用于治疗精心挑选的纤维空洞型肺结核患者，但不适用于空洞大、支气管胸膜瘘多或耐多药肺结核患者。
