支氣管擴張症之手術與臨床照護

Surgical Intervention and Clinical Care for Bronchiectasis

支氣管擴張症是一種慢性不可逆的呼吸系統疾病，令病人經常咳嗽、濃痰、呼吸困難。探討支氣管擴張手術治療適應症、手術方法和臨床照護與支氣管擴張再復發率。本研究採自擬式病患資料登錄表，包括：支氣管擴張節段分佈、臨床症狀、手術時間、手術適應症、手術部位。病人手術預後：含住院天數、有無合併症、術後一個月是否臨床症狀改善及復發。自2009年至2022年期間，總共有89位病患接受胸腔鏡支氣管擴張之肺切除手術，病患平均年齡60.6（±12.29）歲，其中女性有58位（65.2%），男性有41位（34.8%），術前症狀以經常咳嗽居多，有79位（88.8%），其次為濃痰66位（74.2%），咳血49位（55.1%）。89位病患中，其中執行單側肺手術有58位（65.2%），單次同時執行雙側肺手術有31位（34.8%）。手術花費時間:單側肺手術142.64±67.31分，雙側肺手術249.52±87.2分。術後平均住院天數8.57（±5.87）天。幾乎所有病人術後順利出院，住院期間死亡僅1位個案（1.12%），出院後三個月內死亡率0%。除了一位72歲男性病人，術前因支氣管擴張引發部份肺壞死及氣胸，造成呼吸窘迫，為搶救生命而執行壞死肺切除及氣管切開術，術後11天不幸死亡。總之，胸腔鏡肺切除手術是治療支氣管擴張症不可或缺的一種方式，術後再咳血的發生率低，甚至若患者身體功能狀態穩定下，單次同時進行雙側肺手術也是相當安全。

Bronchiectasis is a chronic irreversible respiratory disease that causes frequent coughing, thick phlegm, and dyspnea. The design of this study is based on a simulated patient data registration form, including: segmental distribution of bronchiectasis, clinical symptoms, operation time, surgical indications, and surgical site. Surgical results of the patients: including the postoperative hospital stay, complications, and symptoms improvement and symptom relapsed one month after the operation. From 2009 to 2022, a total of 89 patients underwent thoracoscopic bronchiectasis lung resection, with an average age of 60.6 (±12.29) years, including 58 females (65.2%) and 41 males (34.8%). Frequent cough was the most prevalent symptom, reported in 79 patients (88.8%), followed by thick phlegm in 66 patients (74.2%), and hemoptysis in 49 patients (55.1%). Among the 89 patients, 58 (65.2%) underwent unilateral lung surgery, and 31 (34.8%) underwent simultaneous bilateral lung surgery. Operation time was 142.64±67.31 minutes for unilateral lung surgery, 249.52±87.2 minutes for bilateral lung surgery. The average postoperative hospital stays were 8.57 (±5.87) days. The majority of patients were discharged safely following surgery, with the exception of a 72-year-old male who underwent thoracoscopic lung resection and tracheostomy due to preoperative bronchiectasis-induced pyo-pneumothorax and respiratory distress. Unfortunately, he succumbed on the 11th day postoperatively. In conclusion, thoracoscopic lung resection is an indispensable method for the treatment of bronchiectasis. The incidence of postoperative hemoptysis is low. Even if the patient’s physical function is stable, it is quite safe to perform one-stage bilateral lung surgery.