tuberculosis pneumonectomy

In recent years, due to the advent of effective anti-tuberculosis drugs, the effect of drug treatment of tuberculosis has been significantly improved, and cases requiring surgical resection have been significantly reduced. But for some patients, surgery is still a necessary and effective treatment. Treating diseases: tuberculosis Indication 1. Cavity tuberculosis: Tuberculosis patients with cavities often have cough, bacilli or hemoptysis. After systemic anti-tuberculosis treatment and supportive therapy for more than half a year, if the cavity is not closed, surgery should be selected. Huge cavity, extensive lesions, extensive destruction of lung tissue, peripheral fibrosis, pleural adhesions, less chance of self-healing; tension tuberculosis cavity, often long-term treatment due to endobronchial tuberculosis; thick-walled cavity, its inner wall is thicker The granulation tissue is not easy to heal; the tuberculosis cavity in the lower lobe is not suitable for lung collapse surgery. These patients are indications for lung resection. 2, bronchiectasis caused by tuberculosis or stenosis: chronic tuberculosis often accompanied by endobronchial tuberculosis; hilar lymph nodes can also oppress or erode the bronchial wall, causing bronchial stenosis or dilatation, and some form atelectasis, hemoptysis or co-infection, These patients should undergo a pneumonectomy. 3, lung cheese lesions: large lung cheese lesions, long-term drug treatment is not absorbed; tuberculosis spheres larger than 2cm in diameter, drugs can not penetrate the fibrous tissue wrapped lesions; or suspected cancer is not easy to identify. 4) Destroy the lungs: There are extensive and severe fibrosis and old tuberculosis lesions, which have basically lost lung function, and form pulmonary artery and vein short circuit. Drug treatment is ineffective and lung resection is required. 5, acute massive hemoptysis: repeated continuous hemoptysis or massive hemoptysis (more than 600ml / 24h) caused by tuberculosis, often caused by open tuberculosis, bronchiectasis or hilar calcification lymph node erosion bronchial wall injury bronchial artery, should be an emergency surgery . Contraindications 1, active tuberculosis, patients with severe systemic symptoms are surgical contraindications. A large number of bacteria, body temperature, pulse, erythrocyte sedimentation rate are not normal, although local lesions are suitable for surgery, but the general condition is not suitable for surgery. 2, age: children and tuberculosis patients over 70 years old, the body is weak, surgical treatment should be carefully considered. 3, patients with respiratory insufficiency, especially those with asthma and severe emphysema, other serious organ diseases (such as chronic hepatitis liver damage, liver cirrhosis, severe renal insufficiency, severe cardiovascular disease, diabetes, etc.) Surgical treatment should be carefully considered Preoperative preparation 1, patients should do chest X-ray, chest CT and bronchoscopy to further understand the details of the lesion, (the extent of the lesion, internal structure, relationship with adjacent tissues and blood vessels and changes in the bronchial lumen, etc.), in order to determine the operation Method and extent of resection. 2, cardiopulmonary function test: the assessment of preoperative lung function is very important. Commonly used critical reference values for lung function: the vital capacity is below 1 500 ml, the maximum ventilation is below 40 L/min, the time lung capacity is below 70% in the first second, and the ventilating reserve is below 86%. When selecting a pneumonectomy, the resection should be carefully considered. range. Sometimes, it must be combined with clinical specific conditions, such as the size of the patient's activity, the number of stairs, speed and number of breaths after the activity, pulse, arterial oxygen saturation. For patients undergoing a one-sided pneumonectomy, it is best to measure the lateral lung function. For people with high blood pressure, it should be controlled to the desired level. Patients with myocardial infarction should wait until their condition has stabilized for more than half a year, and surgery should not be considered in the absence of recent angina. 3, choose effective anti-tuberculosis drugs and antibiotics: long-term use of anti-tuberculosis drugs, positive bacteria, should be tested for tuberculosis resistance. When resistance occurs, second-line anti-tuberculosis drugs or new anti-tuberculosis drugs should be added before surgery to ensure the smooth recovery of patients after surgery. Cavity tuberculosis and bronchiectasis, such as more sputum or combined with secondary infections, should be used for bacterial culture and drug susceptibility testing before surgery, and try to reduce the amount of sputum. 4, pay attention to the treatment of other organ diseases: to determine the degree of liver and kidney dysfunction and damage, the impact on the success or failure of surgery. For patients with chronic hepatitis caused by liver dysfunction or renal insufficiency, should be carefully examined and treated. People with diabetes should control their blood sugar and urine sugar levels close to normal to avoid complications after surgery. complication 1, bronchopleural fistula: the most serious and fatal complications, the incidence rate is about 1% to 3%; common in the right side of the heavier tuberculosis lesions, the reason may be preoperative control of sputum positive or more A bacterial infection, diabetes or a history of chest radiation therapy. 2, empyema: the oozing and leakage of the lung section should be handled well, and the effusion remaining in the chest cavity should be completely eliminated. When early detection of intrathoracic infection, timely treatment, the application of a sufficient amount of broad-spectrum antibiotics. 3, tuberculosis spread: mostly occurred in the early postoperative period, mainly caused by a large number of tuberculosis-positive sputum spillover. It should be noted that the operation is gentle and reduces the lung disease. The method of treating the bronchus first and then treating the pulmonary vessels helps to reduce the spread of tuberculosis.

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