目的 探讨耐多药肺结核的手术治疗时机.方法 回顾性分析2009年1月至2016年3月广州市胸科医院39例耐多药肺结核患者的临床资料和随诊结果.患者手术前接受了2～24个月的化疗,化疗强化期末(8个月末)、中期考核(12个月末)和总疗程结束时(24个月末)的患者分别为19例、9例和11例;耐多药、广泛耐药患者分别为21例和18例;病灶范围≤1个肺叶和＞1个肺叶的患者分别为17例和22例.分析耐多药肺结核患者的手术治愈率、并发症发生率,以及不同术前化疗时间、不同耐药种类、不同病灶范围患者的治愈率.结果 39例患者的手术治愈率和成功率均为89.7％(35/39),失败率为10.3％(4/39);手术并发症发生率为20.5％(8/39),包括支气管胸膜瘘(10.3％,4/39)、胸腔感染(5.1％,2/39)、内出血(2.6％,1/39)和伤口感染(2.6％,1/39);术前化疗时间0～、8～、12～24个月的患者的治愈比分别为18/19、8/9、9/11,三组差异无统计学意义(双向无序R×C表的Fisher确切概率法,P=0.665);耐多药、广泛耐药患者的治愈率分别为100.0％(21/21)、77.8％(14/18),差异有统计学意义(x2=5.20,P=0.037).病灶范围≤1个肺叶和＞1个肺叶的患者的手术治愈率分别为94.1％(16/17)、86.4％(19/22),差异无统计学意义(x2=0.63,P=0.429);手术并发症发生率分别为5.9％(1/17)、31.8％(7/22),差异有统计学意义(x2=4.58,P=0.032).结论 耐多药肺结核患者的手术治愈率不会随着术前化疗时间的延长而提高,建议术前进行规则化疗8个月后、广泛耐药肺结核发生之前、病灶范围≤1个肺叶时,积极进行手术治疗.“,”Objective To investigate the chance of operating treatment for multidrug-resistant pulmonary tuberculosis.Methods Clinical data and follow-up results of a total of 39 patients with multidrug-resistant pulmonary tuberculosis in Guangzhou Chest Hospital from January 2009 to March 2016 were retrospectively analyzed.They underwent preoperative chemotherapy for 2-24 months.Nineteen patients underwent 0-8 months preoperative chemotherapy (the strengthening chemotherapy time-point),9 patients underwent 8-12 months preoperative chemotherapy (medium examination time-point),and 11 patients underwent 12-24 months preoperative chemotherapy (total course time-point).Multidrug-resistant and extensively-resistant patients were 21 and 18 cases,respectively.The pulmonary lesion was less than 1 lobe in 17 patients,and was more than 1 lobe in 22 cases.The surgical cure rate,complication rate,cure rate of different time,cure rate of patients with different drug-resistance and the cure rate of different foci were analyzed.Results In 39 cases,both the surgical cure rate and success rate were 89.7％ (35/39),the failure rate was 10.3％ (4/39),postoperative complication rate was 20.5％ (8/39),including bronchopleural fistula (10.3％,4/39),pleural infection (5.1％,2/39),bleeding (2.6％,1/39) and wound infection (2.6％,1/39).The cure rates for patients with 0-8,8-12,and 12-24 months preoperative chemotherapy were 18/19,8/9 and 9/11,respectively,the differences were not statistically significant (Fisher exact probability,P =0.665).The cure rates for multidrug-resistant and extensively-resistant patients were 100.0％ (21/21),77.8％ (14/18),and the difference was statistically significant (x2 =5.20,P=0.037).The cure rates for patients with less than 1 lung lesion range,more than 1 lung lesion range were 94.1％ (16/17) and 86.4 ％ (19/22) respectively,there was no statistically significant difference (x2 =0.63,P=0.429).And their postoperative complications rates were 5.9％ (1/17) and 31.8％ (7/22),respectively,the difference was statistically significant (x2=4.58,P=0.032).Conclsion More preoperative chemotherapy time will not help improving the cure rate.Surgery should be actively applied after 8-month preoperative regular chemotherapy,or before the emergence of extensively drug-resistant pulmonary tuberculosis,or the pulmonary lesion range was less than one lobe.