目的：探讨手术联合化疗治疗耐多药肺结核的临床疗效。方法选取2003年1月至2013年10月收治的耐多药肺结核患者110例。其中72例采取手术+化疗为观察组，38例单纯采取化疗为对照组。比较两组患者治疗后痰菌转阴情况及病灶变化情况，并观察不同程度耐药肺结核患者手术并发症发生和的痰菌转阴情况。结果治疗24个月时，观察组痰菌培养转阴率为87.5%，较对照组痰菌转阴率78.9%显著提高，差异有统计学意义（ P <0.05）；观察组肺部病灶吸收率为80.6%，较对照组病灶吸收率71.1%显著提高，差异有统计学意义（ P <0.05）。观察组术后并发症总发生率为22.2%，病死率1.4%。耐3种药以上组术后痰菌转阴率明显低于耐2种药和耐2种药组，术后并发症的发生率明显高于其他两组，差异均具有统计学意义（ P <0.05）。结论手术联合化疗治疗耐多药肺结核能够提高痰菌转阴率及病灶吸收率，治愈率较高。耐多药肺结核耐药程度越高，术后痰菌转阴率越低，手术的并发症越多。%Objective To explore the clinical curative effect of treating multidrug - resistant tuberculosis through surgery combine with chemotherapy. Methods There were 110 cases of patients with multidrug - resistant tuberculosis. All these patients come to our hospital for treat-ment at the time from January 2003 to October 2013. 72 cases of them are regarded as observation group will be treated with surgery combine with chemotherapy. Another 38 cases of patients are regarded as control group will be treated with chemotherapy. The sputum bacterium turns shade and lesions of those patients in the two groups were compared. The occurrence of surgery illness complication was observed. Results The rate of spu-tum culture turn of observation group was 87. 5% ,which is obviously higher than 78. 9% of the control group. The difference between them have statistical significance( P < 0. 05). The rate of lung lesions absorption of the observation group was 80. 6% ,which is obviously higher than 71. 1% of the control group. The difference between them have statistical significance( P < 0. 05). The rate of occurrence of the total surgery illness complication of the observation group was 22. 2% ,and also have 1 cases of death,which account for 1. 4% . The sputum negative in more than three Kinds of drug - resistant group were significantly lower than two Kinds of drug - resistant and drug - resistant two Kinds of groups. The inci-dence of postoperative complications was significantly higher than the other two groups. The differences were statistically significant( P < 0. 05). Conclusion The method of surgery combined with chemotherapy in the treatment of multidrug - resistant tuberculosis can greatly improve the rate of sputum culture turn and lung lesions absorption. The method have a higher cure rate,and the occurrence of total surgery illness complication and the death rate is also can be accepted. The higher the degree of resistance to the drug,the lower the rate of postoperative sputum negative,the more surgical complications in multidrug - resistant tuberculosis.
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