Clinical Study About Pulmonary Tuberculoma Surgery And Postoperative Anti-tuberculosis Course

Objective: Analyze the factors of affecting the surgical efficacy and complications of patients with pulmonary tuberculoma,and to explore the cure rate,recurrence rate,adverse reaction rate and compliance rate of different postoperative anti-tuberculosis courses,so as to provide reference for clinical surgical treatment of pulmonary tuberculoma and selection of postoperative anti-tuberculosis course.Methods: This study retrospectively collected the cases data of 160 patients with pulmonary tuberculoma who were hospitalized in the department of thoracic surgery of the Lanzhou University Second Hospital from January 2008 to January 2019.The general data of all patients,perioperative data and follow-up data of postoperative antituberculosis treatment were collected and sorted out.The general and perioperative data of 160 patients were analyzed and divided into some groups according to sex,age,location,size,mode of operation(VATS vs thoracotomy)and surgical methods(wedge pneumonectomy,lobectomy,pneumonectomy),in older to study the influencing factors of operative complications and curative effect.To analyze and describe the follow-up data of 135 postoperative anti-tuberculosis patients,and to explore the cure rate,recurrence rate,adverse drug reaction rate and patient compliance rate,as well as the factors affecting compliance.To study the influencing factors of surgical efficacy and the follow-up of postoperative anti-tuberculosis courses from the above studies,and to further explore the experience of selecting different anti-tuberculosis courses.Results: 1.Study on the influencing factors of operative complications and curative effect in 160 patients with pulmonary tuberculoma: the gender of the patients had no significant effect on the operative complications and the curative effect of the operation(p>0.05),so as the age(p>0.05).The effect of focus location on operative complications was statistically significant(p<0.05),but there was no significant difference in operative effect(p>0.05).The effect of focus size on operative outcome was statistically significant(p<0.05),but the effect on operative complications was not statistically significant(p>0.05).The effect of operation mode(VATS vs thoracotomy)on postoperative complications was statistically significant(p<0.05),but there was no significant difference in operative outcome(p>0.05).The operative methods(wedge pneumonectomy,lobectomy and pneumonectomy)had significant influence on the postoperative complications(p<0.05),but there was no significant difference in the effect of operation(p>0.05).2.The study of different anti-tuberculosis courses in 135follow-up patients after operation: the cure rate of patients treated with each antituberculosis course was 100%,and the recurrence rate was 0%.The average incidence of adverse drug reactions in each course of treatment was 43.70%(23.10%-57.10%),among them,the incidence of adverse drug reactions in patients with 3-month and 4-month courses was the lowest(23.10% and 28.60%,respectively).There was no significant difference in the incidence of adverse drug reactions among different courses of treatment(p>0.05).The most common adverse drug reactions in each course were digestive tract reaction(23.70%),liver injury(14.07%)and urinary reaction(8.89%).The total compliance rate of patients in each course of treatment was60.00%(35.70%～84.60%),when the course of treatment was 3 months,there was the highest compliance rate(84.60%).There was no significant difference in compliance rate among different courses(p>0.05).There were significant differences in the compliance of patients with tuberculosis among four factors: education,economic conditions,disease awareness and home address(p<0.05).Conclusions:1.The location of the focus,the mode of operation and the operative methods are the influencing factors of surgical complications,and the diameter of the focus is the influencing factor of surgical efficacy,while age and sex are not the influencing factors of surgical complications and surgical efficacy.2.If the diameter of the focus is smaller than 3 cm and the focus is limited,we can consider shortening the course of anti-tuberculosis after operation(< 3 months).The diameter of the focus is between 3-5 cm,which is recommended for 3 months.The diameter of the focus is more than 5 cm,at least 6 months of anti-tuberculosis treatment.3.Digestive tract reaction,liver injury and urinary system loss are the most common adverse reactions,which should be protected and treated.Education,economic conditions,cognition of the disease and home address are the factors that affect the compliance of patients with anti-tuberculosis treatment,which should be paid more attention during the follow-up.