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Chinese Journal of Thoracic Surgery(Electronic Edition) ›› 2020, Vol. 07 ›› Issue (02): 71-75. doi: 10.3877/cma.j.issn.2095-8773.2020.02.02

Special Issue:

• Original Article • Previous Articles     Next Articles

Microtrauma therapy in pulmonary tuberculosis surgery (39 cases report enclosed)

Yanzheng Song1,(), Yijun Zhu1, Hui Chen1, Hongwei Li1, Lin Wang1, Lei Shi1, Laiyi Wan1, Leilei Li1   

  1. 1. Department of Thoracic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
  • Received:2020-03-10 Online:2020-05-28 Published:2020-05-28
  • Contact: Yanzheng Song
  • About author:
    Corresponding author: Song Yanzheng, Email:

Abstract:

Objective

To study the feasibility and therapeutic effect of micro-trauma therapy in the treatment of pulmonary tuberculosis.

Methods

The results of patients with pulmonary tuberculosis and emphysema over the past 4 years treated by microtrauma therapy were collected and analyzed. Among them, 10 patients (group A) underwent pulmonary tuberculosis resection and empyema clearance by small incision or video-assisted thoracoscopy, and 29 patients (group B) underwent subthoracic resection of pulmonary tuberculosis cavity, tuberculous ball, and aspergillus ball lesions and localized empyema clearance by small incision.

Results

In group A, among the 8 pulmonary tuberculosis cases who underwent video-assisted lobectomy, one case transferred to open chest, and found postoperative bad lung expansion, resulting in pleural effusion on the residual cavity, and the remaining 7 cases with satisfactory pulmonary reexpansion. Their extubation time was as short as 3 days mainly, maximum to 10 days. All patients could get out of bed on the 2nd day after the operation.Video assisted thoracoscopic tuberculous empyema clearance was performed in 2 patients, including 1 patient with complete pulmonary reexpansion and 1 patient with incomplete pulmonary reexpansion. In group B, all 29 cases were cured, with no bronchopleural fistula, no spread of tuberculosis, no sinus formation and other postoperative complications. Their hospital stay was significantly shorter than that of conventional operation. Patients could walk around the bed earlier.Their postoperative recovery of respiratory and circulatory system was faster than that of pulmonary resection patients with less postoperative drainage, extubation time averaging 2-4 days. There were 6 patients with preoperative localized chronic fiber-cavitary pulmonary tuberculosis and positive sputum bacteria, of which 5 cases turned to smear-negative after operation and one showed a significant decrease in the quantity of sputum bacteria. Hemoptysis stopped in the 2 patients complicated with aspergilloma after operation. All patients have been followed up for 4 months-12 years, an average of 6.2 years without recurrence or spread.

Conclusions

The method of minimally invasive wound treatment is a kind of incision which is related to the traditional thoracotomy incision and the micro-invasive incision, and in terms of manual method, the damage is less than the traditional manual method and the mini-invasive method. The surgical treatment of pulmonary tuberculosis should be changed gradually to the treatment of micro-trauma, which is feasible and effective.

Key words: Pulmonary tuberculosis, Surgery, Microtrauma therapy

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