Surgical Treatment of Pulmonary Tuberculosis

Since 1949, the implementation of prevention-oriented health care policy, the tuberculosis incidence rate has gradually decreased also due to carry out the census, found that patients in time to get a reasonable medical treatment to effect a better anti-TB drugs have come out in succession And therefore need to surgical treatment of patients has become increasingly reduced. But there is still a small number of patients due to receive timely and appropriate medical treatment, or because of bacterial resistance, resulting in effective drug treatment can not, and will need surgery.
Surgical treatment of tuberculosis combination therapy is only an integral part of its purpose is serious damage to the removal of tuberculosis lesions, lung disease or wilting depression, promote their healing. Surgery itself often can not eliminate all the primary and Mycobacterium tuberculosis, so special attention should be given before and after the general anti-tuberculosis therapy, can improve the cure rate to prevent and reduce post-operative complications or disease recurrence.
TB treatment is currently the most common lung resection, followed by the thorax angioplasty. As for other types of depression therapy wilt and empty drainage, and other methods in recent years have been very few applications.
Pneumonectomy
For the treatment of pulmonary tuberculosis, suffered serious damage is difficult to restore the removal of the lung, began in the late 19th century. In a fairly long period of time, due to mortality and the high incidence of postoperative complications, has not been promoting. Until the 1940s, streptomycin, isoniazid and sodium Liu ammonia, and other effective anti-TB drugs have come out in succession, so that tuberculosis infection before surgery can be limited and controlled so that the residual disease after the operation access to treatment, To clinicians on the respiratory and circulatory physiology understanding of the continuous improvement, surgery and anesthesia, and other technical improvements, the surgery only to promote the use of, and have achieved satisfactory results, so that 90 to 95 per cent of the cases are successful, only one percent mortality Around.
[Surgical indications:
Empty-cheese-like tuberculosis TB liquefied dissolved after the change from a bronchial empty. If the formal long-term medical treatment is not closed, in particular the continued positive sputum, Jianhou fibrous tissue around the thick-walled empty, bronchial diseases and poor drainage of tension empty, 3 cm in diameter greater than the enormous empty, and wilt depression The surgery does not work under the Department of hilar or nearly empty, and so on, should be considered at an early stage lung resection. This is a source of infection to eliminate and prevent the spread of tuberculosis prevention significance.
Lung damage lung leaf or the side of a wide range of fiber cheese-like lesions, often accompanied tuberculosis bronchiectasis are scattered in many small and empty. The leaf or the side of the lung has basically lost their respiratory function, Duotan, hemoptysis and long-term positive sputum. If no significant activities contralateral lung TB changed, lung function and systemic conditions permit, in accordance with the scope of a disease or the side lobe lung resection.
Tuberculosis bronchiectasis or narrow for the aftermath of endobronchial tuberculosis. If repeated hemoptysis, or sputum-positive in atelectasis, required surgical resection of the lung.
TB-pathological changes of its main package of cheese is like tuberculosis or necrotic tissue granulation tissue. If the diameter greater than 2.5 cm, we can not rule out lung cancer, or sputum-positive, should surgery. Smaller diameter, asymptomatic, sputum negative and conditional regular follow-up inspection, without surgery.
[Surgery contraindications:
Lung resection planned trip outside the scope of the lung or bronchial have active tuberculosis were changed.
Other parts of the body while TB lesions, despite anti-tuberculosis treatment, but were unable to control.
Lung and other organ function can not tolerate surgery.
[The choice] surgical operation principle is as far as possible, with serious damage to the lung disease as much as possible while retaining a healthy lung tissue. Therefore, in accordance with the scope of diseases, can be selected resection of the lung, the whole side of lobectomy or lung resection. Occasionally the limitations of the implementation of superficial lesions wedge lung resection. Bilateral pulmonary lesions were removed indications, should be based on the patient's specific situation, consider the same period or phased lung, and / or lobectomy.
If lesions confined to a single lobe, while the remaining lung were normal, as far as possible the purposes of lobectomy and less of a lung removed because of medical statistics showed that the lungs of the leakage after chest infection and the incidence rate higher than lobectomy. Conversely, if the disease spread to the same side with a lung lobe more, with some disease is limited to one or some of the lung, to retain as much as possible-lung tissue, maintain lung function, implementation of a number of lung or pulmonary Of the increase lobectomy, for example, often use the right lung on the tip of the increase after the next Yebei of resection. Otherwise, if, under the leaves are doing lobectomy, a right lung removed because of the mid-size smaller right lung, should not be separate reservations.
[Ready] before surgery
Bronchoscopy on sputum positive, the inspection should be made to understand outside the scope of the removal of bronchial whether active TB change. If there is disease, should continue to anti-tuberculosis treatment, to be controlled after surgery. Otherwise easily have bronchopleural sputum, and other complications.
Pulmonary function tests required a more extensive lung resection, but there are still certain that part of the respiratory lung function, inadequate performance of the peace who is known as pulmonary function, lung function should be examined to estimate whether their tolerance surgery. The damage of the lung or single-lung resection, such as lung function no less than clinical examination performance may generally be exempted from inspection.
Strengthen anti-TB drugs to treat patients before surgery should be not less than six months after the formal anti-tuberculosis drug treatment and before surgery recently, for use in peacetime is not used by the more or less effective anti-TB drugs, for example, to vary smoke Hydrazine, Liu sodium ammonia for rifampin, ethambutol, and so on. Of one to two weeks before the start of streptomycin intramuscular injection or kanamycin. In the anti-TB drugs under the protection of the full implementation of surgery to prevent or reduce the incidence of surgical complications, and the deterioration of residual disease or development.
Cavitary tuberculosis and a bronchodilator, sputum more patients, preoperative treatment should be strengthened, including postural drainage and control of secondary infection of the drugs, to ensure that the sputum less, to reduce overflow into the sputum of the other The lungs, caused TB to spread.
[Post-operative treatment:
Pulmonary tuberculosis after early attention to issues and general treatment, and non-pulmonary TB lesions removed the same.
Continue to maintain the operation before the treatment with anti-TB drugs. And after discharge in two oral anti-TB drugs. Every three months and make a review of the chest film, when the withdrawal, as the case may be, generally at least six months treatment. Premature withdrawal will lead to disease recurrence or residual disease worsened.
[Lung removed after the chest cavity of the residual lung resection after treatment - left over from the larger chest cavity residues, easily lead to chest infection and bronchopleural fistula from occurring. In addition, the presence of residual cavity to the same side and the contralateral lung emphysema in compensatory and easy to lead to the recurrence of residual disease or deterioration. In addition, since the trachea and mediastinal shift and compensatory emphysema, the impact of heart and lung function, lung resection of a surcharge should be eliminated or reduced within the chest cavity of the residual measures.
Pneumonectomy for the side or over the same side or contralateral lung disease are still remnants of lobectomy should be attached thorax angioplasty. Under normal circumstances, the lobectomy, the removal of clothing, the first two to five ribs, lung resection, with No. 2 to 8 as part of rib, chest wall to collapse the soft tissue, to eliminate or reduce the residual cavity. Under normal circumstances, angioplasty for chest and lung resection of the purposes of the same period. If a patient poor general condition, pulmonary surgery itself has lasted longer, or more, such as bleeding, may be in the lungs after three to four weeks, again thorax angioplasty. Small age, physical development is not yet mature enough, not the broader purposes of the thorax angioplasty, so as to avoid collapse because of thoracic surgery side, players can not be long growth and the corresponding expansion, resulting in serious scoliosis and body deformation.
I had no residual lung lesions with a single leaf or leaves on the middle or lower lobe resection, without the purposes of general thoracic angioplasty. In order to reduce residue within the chest cavity, can be more than adequate separation of the lung and pleural layer of adhesion between crack and the adhesion to cut off the ligament lung, lung to make more than the full expansion. After the same side will have to raise the diaphragm, the need for fashion to every muscle pneumoperitoneum increased to reduce the residual thoracic cavity.
Paragraph after lung, pulmonary section continued to leak more than seven to 10 days without stop the trend, or in bronchopleural fistula, the timely implementation of fistula repair, and more thorough additional thoracic angioplasty to prevent the occurrence of empyema And development. Lobe of the lung or after 2 to 3 weeks, X-ray inspection showed more than poor lung expansion and lung lower than No. 5 on the sector after the rib level, should also consider the implementation of local thoracic angioplasty, to eliminate the residual within the chest cavity.
[Treatment outcome for the treatment of pulmonary tuberculosis - the result, depending on the indications have surgery, surgical treatment and surgery before and after treatment. In all areas and properly handle the cases, most patients can be successful rehabilitation, long-term effect is relatively good. According to 1959 some 10 provinces and cities to statistics, 4,826 cases of pulmonary tuberculosis surgical resection of the mortality rate was 1.5 percent, of which there are several groups of lobe of the lung resection surgery mortality rate at 0.5 percent, and the whole lung resection and A variety of lung resection surgery mortality rate was higher.
Thorax angioplasty
Thorax angioplasty or change shape of thorax, is a wilt depression therapy, lung disease through the removal of the corresponding part of rib, chest wall invagination, the compressed lung disease and wilt depression, to enable it to rest, the organization is conducive to healing And the promotion of empty closure. Meanwhile, wilt the depression of blood and lymph return slowed down, can reduce the toxic absorption, and local relative lack of oxygen, not conducive to breeding tuberculosis. Thorax angioplasty is streptomycin and other anti-TB drugs available before the more common and effective treatment methods. Nearly 30 years ago, at home and abroad extensively carried out in the treatment of pulmonary tuberculosis, and has achieved satisfactory results. Due to lung resection than thorax angioplasty after a rapid recovery, there is no chest deformities, and other advantages, Guchang for patients and surgeons to accept. However, the need for surgical treatment and not suitable for the purposes of lung resection of the patients, thoracic angioplasty is still an effective method. Therefore, the two co-operation both the indications, also have their own special indications.
[Indications]
On the side of the hollow fibers with chronic lung or large fiber cheese disease, sputum-positive, also under the leaf lesions. Such cases such as lung resection line therapy, may be required for lung resection, too much loss of lung function, and the need for additional thorax to form, to reduce the residual chest cavity, if only line of excision, also need some additional Thorax angioplasty to prevent the lower lobe lung lesions due to excessive swelling and deterioration.
Bilateral chronic fibers on the leaves empty, could be considered for staging bilateral thoracic angioplasty.
Side of the lung damage, no lesions or contralateral disease has stabilized, although also for lung resection, but if patients generally poor, or the estimated lung resection difficulties and a greater danger may consider implementation of thoracic angioplasty.
[Contraindications:
Exudative or invasive lesions consisting mainly of tuberculosis. Medication should be used mainly to the non-surgical therapy.
Tanduo or repeated hemoptysis, or tension empty bronchial tuberculosis change to the merger.
Thick-walled empty, under the leaves or near the mediastinum empty.
TB ball.
Minors patients. Will significantly after the scoliosis deformity.
[Points] a typical operation thoracic angioplasty is the phased removal ribs, top-down operation carried out. Each with the number of ribs is generally not more than three to four, each with enough ribs to the length of thoracic transverse process, including the back-end, front-end in the last three ribs, including some costal cartilage, the following reservations gradually more front-end ribs. With the root of several ribs should be based on the location and extent of disease which, under the disease normally takes up to two ribs. Time between each phase of operation for two to three weeks, periosteal stripping and ribs removed, to prevent injury pleural layer, to avoid blood, and pneumothorax. The event should be placed chest tube drainage.
In order to avoid multi-stage operation, there had been some improvement technique, but long-term effects than typical surgery. It was also advocated by the requirements of a typical operation, a completed and after surgery using soft dressing to soften the chest compression bandage and avoid early postoperative thoracic abnormal respiratory movement. The general situation in their prime and better-off patients, could be considered a complete operation.
[Pre-operative preparation and post-operative treatment - surgery and pre-lung resection is basically the same.
Post-operative treatment: surgery after the end of gauze with Miandian Mission at the chest wall or softening, external chest with dressing, and maintain the chest wall collapse, reducing abnormal chest wall respiratory movement. After surgery to keep head and neck, shoulder and spine in the normal attitude of, to avoid bias contralateral head and neck, thoracic surgery process to the side, the side of the shoulder elevation, and other deformities.

After dealing with other large and similar lung resection. As TB lesions still exist, after anti-tuberculosis drug rehabilitation treatment and convalescence period is required extended accordingly. 2 to 3 per month sputum, ESR, chest radiography, such as inspection, such as two consecutive negative sputum, ESR normal, empty has been closed, no new lesions and lung lesions showed stability in the original state, when the whole body in good condition May be appropriate to increase activity, and to consider resumption of work.