Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Medicine, College of Medical College, National Cheng Kung University, Tainan, Taiwan.
PLoS One. 2018 May 15;13(5):e0197283. doi: 10.1371/journal.pone.0197283. eCollection 2018.
We retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy.
Of 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmentectomy between January 1996 and November 2015 were reviewed. Clinical information and computed tomography (CT) image characteristics were investigated and analyzed.
Eighteen patients underwent direct or intended thoracotomy. Sixty-four underwent video-assisted thoracoscopic segmentectomy (VATS), including 53 multi-incision thoracoscopic segmentectomy (MITS), and 11 single-incision thoracoscopic segmentectomy (SITS). Thirty-nine were converted to thoracotomy. The intended thoracotomy group had more operative blood loss (p = 0.005) and hospital stay (p = 0.001) than the VATS group although the VATS group had higher grade of cavity (p = 0.007). The intended thoracotomy group did not differ from converted thoracotomy in operative time, blood loss, or hospital stay, and the grade of pleural thickening was higher in the converted thoracotomy group (p = 0.001). The converted thoracotomy group had more operative blood loss, hospital stay, and complication rate than the MITS group (p = 0.001, p<0.001, and p = 0.009, respectively). The MITS group had lower pleural thickening, peribronchial lymph node calcification, cavity, and tuberculoma grading than the converted thoracotomy group (p<0.001, p = 0.001, 0.001, and 0.017, respectively). The SITS group had lower grading in pleural thickening, peribronchial lymph node calcification, and aspergilloma grading than the converted thoracotomy group (p = 0.002, 0.010, and 0.031, respectively). Four patients in the intended thoracotomy group and seven in the converted thoracotomy group had complications compared with three patients in the MITS and two in the SITS group. Risk factors of conversion were pleural thickening and peribronchial lymph node calcification.
Although segmentectomy is technically challenging in patients with pulmonary TB, it could be safely performed using MITS or SITS and should be attempted in selected patients. Its efficacy for medical treatment failure needs investigation.
我们回顾性分析了肺结核（TB）肺段切除术的演变过程，以及多切口和单切口电视辅助胸腔镜肺段切除术的可行性。
对 1996 年 1 月至 2015 年 11 月间 348 例因 TB 接受手术的患者的病历进行回顾性研究，分析了临床资料和 CT 图像特征。
18 例患者直接或拟行开胸手术。64 例行电视辅助胸腔镜肺段切除术（VATS），其中 53 例行多切口胸腔镜肺段切除术（MITS），11 例行单切口胸腔镜肺段切除术（SITS）。39 例中转开胸。与 VATS 组相比，意向开胸组的手术出血量（p = 0.005）和住院时间（p = 0.001）更多，但 VATS 组的空洞程度更高（p = 0.007）。意向开胸组与中转开胸组在手术时间、出血量和住院时间方面无差异，而中转开胸组胸膜增厚程度更高（p = 0.001）。中转开胸组的手术出血量、住院时间和并发症发生率均高于 MITS 组（p = 0.001，p<0.001 和 p = 0.009）。MITS 组胸膜增厚、支气管周围淋巴结钙化、空洞和结核瘤分级均低于中转开胸组（p<0.001，p = 0.001，0.001 和 0.017）。SITS 组胸膜增厚、支气管周围淋巴结钙化和曲霉菌瘤分级均低于中转开胸组（p = 0.002，p = 0.010 和 p = 0.031）。意向开胸组 4 例和中转开胸组 7 例患者发生并发症，而 MITS 组 3 例和 SITS 组 2 例患者发生并发症。胸膜增厚和支气管周围淋巴结钙化是中转开胸的危险因素。
虽然肺结核患者行肺段切除术具有一定的技术挑战性，但通过 MITS 或 SITS 可以安全地进行，且应在选择的患者中尝试。其对治疗失败的疗效有待进一步研究。
