胡汶斌　袁顺达　陈雪芳

[摘要] 目的 總结分析老年人结核性毁损肺围手术期处理的经验。 方法 回顾性分析绍兴市立医院及绍兴市人民医院2008年1月～2016年6月30例65岁以上老年手术治疗结核性毁损肺患者的临床资料，对其疗效进行分析。结果 行胸腔镜辅助小切口26例，标准后外侧切口4例，14例行右肺上叶切除，2例行右肺中上叶联合切除，10例左上肺切除，3例左全肺切除，1例右全肺切除。手术时间150～330 min，平均（240±29）min，术中出血400～5000 mL，平均（600±125）mL，术后放置胸管时间5～21 d，平均（10.0±2.7）d，术后并发肺部感染伴节段性肺不张12例，心律失常11例，心衰3例，哑型肺栓塞2例，胸腔大量渗血1例，反复少量咯血1例，均采用药物治疗治愈。2例患者因术后健侧肺部感染导致呼吸衰竭而死亡，余28例随访，失访2例，26例随访6～60个月，效果满意。 结论 对于老年结核性毁损肺患者必需严格掌握手术适应证，把握最佳手术时机，术前充分准备，娴熟的手术操作和及时、有效地处理术后并发症，以提高其手术安全性，降低病死率。

[关键词] 毁损肺；老年人；围手术期；肺切除术；结核

[中图分类号] R655.3 [文献标识码] B [文章编号] 1673-9701（2018）20-0068-04

Perioperative management of pulmonary tuberculosis damage in the elderly over 65 years old

HU Wenbin1 YUAN Shunda1 CHEN Xuefang2 ZHANG Liuya1 ZHANG Kang1 HAN Xiaoliang1 SU Chao1 WEI Desheng3

1.Department of Thoracic Surgery， Shaoxing Municipal Hospital， Shaoxing 312000， China； 2.Department of Science and Education， Shaoxing Municipal Hospital， Shaoxing 312000， China； 3.Department of Thoracic Surgery， Peoples Hospital of Shaoxing， Shaoxing 312000， China

[Abstract] Objective To summarize and analyze the experience of perioperative management of pulmonary tuberculosis damage in the elderly. Methods The clinical data of 30 cases who were 65 years of age or older and took pulmonary tuberculosis damage surgery in Shaoxing Municipal Hospital and Peoples Hospital of Shaoxing from January 2008 to June 2016 were analyzed retrospectively and therapeutic effects were also analyzed. Results Video-assisted thoracic small incision surgery in 26 cases， standard posterolateral incision surgery in 4 cases， 14 cases of right upper lobe resection， 2 cases of right combined with upper lobe resection， 10 cases of left upper lung resection， 3 cases of left pneumonectomy， 1 case of right pneumonectomy. The operation time was 150-330 min（mean， 240±29） min. The intraoperative blood loss was 400-5000 mL（mean， 600±125 mL）. The time of postoperative chest tube placement was 5-21 d （average， 10.0±2.7） days. Pulmonary infection with segmental atelectasis in 12 cases， arrhythmia in 11 cases， heart failure in 3 cases， dumb pulmonary embolism in 2 cases， pleural bleeding in 1 case， repeated hemoptysis of a small amount in 1 case， all above were treated with drug therapy. Two patients died of respiratory failure due to contralateral pulmonary infection， and 28 patients were followed up， 2 patients were lost to follow-up， and 26 patients were followed up for 6-60 months with satisfactory results. Conclusion It is necessary to strictly control the indications for the elderly patients with destructive tuberculous pulmonary diseases to grasp the optimal timing of surgery. Adequate preparation before surgery， skilled surgical operation， timely and effective treatment of postoperative complications can improve the safety of surgery and reduce the incidence of death rate.

[Key words] Lung damage； Elderly； Perioperative； Lung resection； Tuberculosis

结核性毁损肺是指肺叶或一侧全肺组织已形成不可逆改变，大多伴有广泛干酪样病变、空洞、纤维化、支气管扩张等，肺功能丧失，结核菌耐药，内科药物治疗效果差，且极易成为感染源，需外科手术介入。绍兴市立医院与绍兴市人民医院自2008年1月～2016年6月共手术治疗65岁以上结核性毁损肺患者30例，取得良好效果，现报道如下。

1 资料与方法

1.1 临……