Rabiou S, Issoufou I, Ammor F Z, Harmouchi H, Belliraj L, Lakranbi M, Serraj M, Ouadnouni Y, Smahi M
Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc.
Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc.
Rev Pneumol Clin. 2017 Sep;73(4):199-205. doi: 10.1016/j.pneumo.2017.06.003. Epub 2017 Jul 27.
Bronchiectasis is a serious and disabling disease. Surgical treatment is an interesting alternative to be proposed early to patients in case of complications or deterioration of quality of life, despite an optimal medical treatment. Through this retrospective study and literature review, we analyze surgical results for bronchiectasis.
We conducted a monocentric, retrospective, descriptive and analytical study in the Department of thoracic surgery of CHU Hassan II Fès, about 64 patients operated for bronchiectasis during the period from January 2009 to December 2016.
There were 30 men and 34 women with an average age of 32years. Twenty six percent (26 %) had a history of recurrent lung infection, and 17.18 % would have been treated for pulmonary tuberculosis and declared cured. Productive cough (93 %), morning chronic bronchorrhea (92 %) and repeatedly hemoptysis (62.5 %) were the main symptoms. On CT scanning, the bronchiectasis was unilateral and localized in 49 cases. The right lung was involved in 27 cases and the location was bilateral in 15 cases. It was 38 cystic bronchiectasis, 16 cylindrical bronchiectasis, and 10 mixed lesions predominantly cylindrical. The flexible bronchoscopy carried out in 34 cases, had shown a carcinoid tumor in 1 case, a bronchiolithiasis in 1 case and a intrabronchial foreign body in 1 case. The incision was a conservative posterolateral thoracotomy in all cases. The performed surgical procedure was lobectomy in 53 % of patients. The morbidity rate was 32.80 % and dominated by septic complications. After a mean follow-up of 20.52months, 2 cases of recurrence minimal hemoptysis and 1 case of renewed bronchorrhea are noted. For all other patients the outcome was favorable and no deaths have been noted to date.
The surgery of bronchiectasis requires a perfect collaboration between the pulmonologist, the thoracic surgeon, the anesthesiologist, the biologist and particularly the physiotherapist for an optimal care of patients.
支气管扩张是一种严重且致残的疾病。尽管进行了最佳的药物治疗,但在出现并发症或生活质量恶化的情况下,手术治疗是一种值得早期向患者推荐的有效选择。通过这项回顾性研究和文献综述,我们分析了支气管扩张的手术结果。
我们在胡塞因二世大学费斯胸外科进行了一项单中心、回顾性、描述性和分析性研究,研究对象为2009年1月至2016年12月期间接受支气管扩张手术的64例患者。
患者中有30名男性和34名女性,平均年龄为32岁。26%的患者有反复肺部感染史,17.18%曾接受过肺结核治疗并宣告治愈。主要症状为咳痰(93%)、晨起慢性支气管溢液(92%)和反复咯血(62.5%)。在CT扫描中,49例支气管扩张为单侧且局限。右肺受累27例,15例为双侧受累。其中38例为囊状支气管扩张,16例为柱状支气管扩张,10例为以柱状为主的混合性病变。34例患者进行了纤维支气管镜检查,其中1例发现类癌肿瘤,1例发现支气管结石,1例发现支气管内异物。所有病例均采用保守的后外侧开胸手术。53%的患者接受了肺叶切除术。发病率为32.80%,主要为感染性并发症。平均随访20.52个月后,发现2例有少量咯血复发,1例再次出现支气管溢液。对于所有其他患者,结果良好,迄今为止未发现死亡病例。
支气管扩张手术需要肺科医生、胸外科医生、麻醉师、生物学家,尤其是物理治疗师之间的完美协作,以实现对患者的最佳护理。