胸壁结核的手术治疗

目的探讨胸壁结核的手术治疗方法。方法回顾分析246例胸壁结核病人的手术治疗经验教训,总结出完善的术前准备、合理的抗痨方案、彻底的病灶清除是手术成功的保障。结果246例病人术后伤口全部愈合,1年内复发5例,经二次手术治愈。结论胸壁结核术前需做完善的术前准备,正规的抗结核治疗,合适的手术时机,彻底的病灶清除,术后抗结核治疗6～9月以上,可避免或减少术后复发。     

胸壁结核的外科治疗

目的 探讨胸壁结核的临床特点及疗效。方法 回顾性分析28例胸壁结核患者的临床资料。所有患者均行病灶清除术治疗，术后抗结核治疗9—12个月。结果 所有患者均获得治愈，随访1-2年无复发。结论 胸壁结核是以胸壁冷脓肿为主要特点，其主要治疗方法是手术治疗结合术前、术后抗结核药物治疗，而手术成功的关键是彻底清除病灶，消灭死腔。     

分期人工膝关节置换术治疗晚期复杂重度活动性膝关节结核疗效分析

目的 探讨一期病灶清除术并二期人工膝关节置换术(total knee arthroplasty, TKA)治疗晚期复杂重度活动性膝关节结核的可行性及临床疗效。方法 回顾性分析2015年1月至2019年12月在我科行分期TKA术治疗的12例晚期复杂重度活动性膝关节结核患者的临床资料,年龄21～71岁,平均50.6岁。所有患者均行病灶清除术和围手术期抗结核治疗：一期抗结核化疗至少2周后行病灶清除术(其中7例植入spacer),再行至少3个月的抗结核化疗;待C反应蛋白(CRP)、红细胞沉降率(ESR)降至正常值2倍以内,伤口愈合良好后行二期TKA,术后继续抗结核化疗8～9个月。采用HSS膝关节评分和膝关节活动度评估膝关节功能。结果 所有患者随访36～76个月,规律抗结核治疗12～20个月,均未发现肺结核复发或重叠感染。一期手术后2～9个月ESR降至正常值2倍以内,1～6个月CRP降至正常值2倍以内;二期手术后2～5个月ESR降至正常值2倍以内,1～2个月CRP降至正常值2倍以内。末次随访所有患者无结核复发,复查X线未见假体松动,膝关节HSS评分和膝关节活动度分别为(82.58±9.14)分和...     

负压封闭引流技术应用于胸壁结核治疗（附38例报道）

目的 通过更换引流方式,探讨胸壁结核术后应用负压封闭引流（VSD）的疗效。方法 回顾分析38例胸壁结核并窦道形成患者,术前常规三联抗痨一个月后,行手术彻底切除结核病灶,术后使用负压封闭引流,病愈出院后继续三联抗结核6个月。结果 38例患者一次性治愈率100%,随访1~2年无复发。结论 胸壁结核术前需正规的抗结核治疗,彻底行病灶清除,术后使用负压封闭引流方式,并继续抗结核治疗,可有效减少或避免术后病灶复发。     

胸壁结核外科治疗的护理

胸壁结核绝大多数为继发感染,最常见原发病变为肺结核、胸膜结核和纵隔淋巴结核[1],是指胸壁软组织、肋骨、肋软骨及胸骨发生的结核病变,以青少年和年老体弱者多见。胸壁结核病灶清除术适用对象为经保守疗法不能治愈或脓肿较大的患者[2]。2006-02~2008-07我院共收治胸壁结核患者27例,全部行病灶清除术,经过术前的详细检查,细致的心理护理,术后对不同阶段伤口的观察护理,规范的抗结核治疗及全面的健康教育,患者全部痊愈出院。1临床资料本组27例中男13例,女14例,年龄15~84岁,平均46.2岁。有结核病史的16例(59.3%)。首次治疗25例,复发后再次治疗2例。伤口Ⅰ期愈合25例,Ⅱ期愈合2例,愈合率为92.6%。术中因病变侵蚀切除部分肋骨6例(22.2%)。2护理2.1术前准备2.1.1术前检查:(1)常规检查。术前常规检查心电图、肺功能、肝肾功能等,并记录生命体征。以了解有无手术禁忌证。(2)特殊检查。因胸壁结核常继发于肺或胸膜结核、纵隔淋巴结核,因此术前一定要查痰抗酸杆菌,以确定是否处于结核活动期。25例痰菌阴性患者,短期安排手术。2例痰菌阳性患者,考虑有活动性肺结核,为了避免术后复发先强化抗结核治疗...     

脊柱结核外科治疗的探讨

目的总结采用彻底清除病灶和植骨消灭死腔，通过坚强内固定矫正畸形和重建脊柱稳定性治疗脊柱结核的疗效。方法自1996年10月至2002年7月共手术治疗脊柱结核152例，结核病灶位于颈椎15例、胸椎67例、胸腰段17例、腰椎53例，病灶范围1～3个椎体，无跳跃病灶。手术方法：(1)前路一期病灶清除植骨、钢板内固定；(2)经肋横突切除入路行病灶清除植骨、经椎弓根内固定；(3)后方入路行病灶清除、植骨融合和椎弓根内固定；(4)前路病灶清除植骨、后路椎弓根固定。术后配戴支具3～5个月，抗结核药物治疗6～9个月。定期进行实验室检查和影像学观察。结果(1)手术时间和出血量：前后路联合手术平均术时4．5h，术中平均出血650ml；前路一期病灶清除植骨内固定，平均术时3．5h，术中平均出血450ml；其余两种手术平均术时3．0h，术中平均出血350ml。(2)手术创伤和并发症：前后路联合手术创伤较大，前路一期病灶清除植骨内固定术次之。手术并发症有大血管破裂1例，暂时性窦道形成5例，内固定器松动和断裂3例。(3)临床疗效：患者术后1～2周症状基本缓解并下床行走，术后6～8周日常生活基本自理，术后6个月X线片显示植骨融合。患者结核病灶全部治愈。结论有效应用抗结核药物是脊柱结核手术成功的前提，坚强内固定有利于矫正后凸畸形、重建脊柱稳定性、促进植骨融合。抗结核药物和病灶彻底清除是内固定安全植人的前提。脊柱结核的外科治疗应该是病灶清除、减压矫形、植骨融合和坚强固定。     

脊柱结核临床治疗要点回顾分析

目的 探讨脊柱结核临床治疗的要点。方法 回顾性分析2001-01-2010-01,我科收治的脊柱结核并脊髓损伤患者105例。化疗后3-4周手术,采用一期前路病灶清除、植骨、内固定手术治疗,术后严格强化四联抗结核治疗,术后3个月改三联化疗9-15个月。神经功能障碍改善情况采用ASIA神经功能评价,对其神经功能恢复、病灶愈合及内固定情况等进行分析研究。结果 1例术后3月后因结核性脑膜炎医治无效死亡。1例术后4月出现臀部脓肿复发,原发病灶未复发,再次手术清除后治愈。所有患者获随访4-12年,平均7.8年。脊柱病灶无复发。血沉均恢复正常,随访末期X线片均获骨性融合。结论 脊柱结核临床治疗要点应在标准化疗基础上尽早手术,一期病灶清除、植骨、内固定治疗,效果满意。     

病灶清除植骨内固定治疗相邻多椎体脊柱结核

目的:探讨病灶清除、植骨及内固定术治疗相邻多椎体脊柱结核的疗效.方法:1999年1月～2007年1月手术治疗27例相邻多椎体脊柱结核患者.病变累及3个椎体15例,4个椎体7例,5个及以上椎体5例,病变单纯累及胸椎者5例,单纯累及腰椎者7例,累及胸腰椎者11例,累及腰骶椎者4例.术前有神经功能损害者11例,Frankel分级B级1例,C级2例,D级8例.后凸Cobb角26°～43°,平均35°±7°.术前均采用口服异烟胼(H)、利福平(R)、乙胺丁醇(E)并肌注链霉素(S)四联药物方案(HRES)抗结核治疗3周,一期后路内固定、前路病灶清除植骨16例,前路病灶清除植骨融合内固定11例.术后继续HRES扰结核治疗3个月,然后口服HRE三联药物方案抗结核治疗9个月.采用吴启秋骨结核治愈标准对疗效进行评估.结果:手术时间150～300min,平均240min;术中出血量600～1400ml,平均1000ml.术后无神经功能障碍加重及脑脊液漏等并发症.1例术后伤口出现寞道Ⅱ期愈合,其余均Ⅰ期愈合.脊柱后凸Cobb角恢复至120～20°,平均15°±5°.27例均获随访,随访时间14～48个月,平均18个月,有神经功能损害者于术后8个月内恢复至正常;植骨伞部融合,融合时间5～14个月,平均7个月.随访期间内固定无松动及折断.末次随访时所有患者均获临床治愈.结论:在有效抗结核药物治疗的基础上,多椎体脊柱结核采用彻底病灶清除、植骨融合及内固定术加强脊柱稳定,可提高植骨融合率和治愈率.获得满意的疗效.     

一期后路病灶清除植骨融合内固定治疗腰骶椎结核

目的 探讨一期后路病灶清除植骨融合内固定治疗腰骶椎结核的可行性及临床疗效.方法 21例腰骶椎结核患者经正规抗结核治疗2～4周,行一期后路病灶清除植骨融合内固定术,联合术后规范化抗结核治疗12～18个月.结果 手术时间150～240(180±32)min;术中出血量400～800(600±84)ml;术中无神经、硬膜、大血管损伤.术后1例切口出现窦道形成二期愈合,其余切口均一期愈合.患者均获随访,时间24～54(36.5±2.3)个月.术后1年均植骨融合.末次随访时腰骶角为24.5°±5.3°;患者脊柱结核均治愈,无复发;8例神经功能障碍者均恢复至Frankel E级.结论 在规范化抗结核治疗基础上行一期后路病灶清除植骨融合内固定治疗腰骶椎结核安全、有效,但应严格掌握适应证.     

前路病灶清除植骨钛板内固定治疗颈椎结核

目的 探讨颈椎前路病灶清除植骨内固定治疗颈椎结核的手术方法和疗效.方法 2000-01-2010-01对16例颈椎结核患者,术前四联抗结核治疗2～3周,采用前路病灶清除、椎间植骨、钛钢板内固定术,术后继续抗结核12～18个月.术后随访1～5年,平均2年.回顾性分析手术适应证及优势,术后症状改善、远期疗效等.结果 所有患...     

The role of surgery in chest wall tuberculosis

Chest wall tuberculosis is a rare entity and its clinical presentation may resemble a pyogenic abscess or chest wall tumor. The role of surgery in the diagnosis and treatment of chest wall tuberculosis is still controversial. During a 6-year period (1997-2002), six cases with cold abscesses of chest wall were managed in our clinic. Clinical presentation, diagnostic workup, treatment strategies, and results of medical and surgical treatment were retrospectively reviewed. There were four male and two female patients. All but one had a fluctuating and abscess-like chest wall mass. Pleura and mediastinal or chest wall lymph nodes were also involved in three patients. Before the debridement and abscess drainage, the diagnosis was not confirmed in any of our patients except one. All received a four-drug antituberculous regimen for 6-12 months postoperatively and improved clinically and radiologically. Surgical intervention and histological examination are usually necessary for the treatment and to confirm the diagnosis in chest wall tuberculosis. Antituberculous medical treatment and adjunctive surgery are quite effective in this process.     

Management of Primary Chest wall Tuberculosis

Primary tuberculosis of the chest wall is rare and its clinical presentation may resemble pyogenic abscess or tumour. The diagnosis is difficult, since smears or cultures of aspirate frequently fail to show tubercle bacilli. Seven cases of primary chest-wall tuberculosis treated between 1973 and 1992 are described. All presented with a progressively enlarging mass. The diagnosis was based on bacteriologic and histologic findings, but definitive diagnosis was obtained before treatment in only two cases. Satisfactory results were obtained with surgical debridement and specific chemotherapy in six cases and with chemotherapy alone in one case. From this limited experience, we suggest that primary chest-wall tuberculosis should initially be treated with a combination regimen of antituberculous chemotherapy, which should take more than 9 months. If the lesion progressively enlarges or secondary infection occurs, however, adequate surgical debridement is also required.     

363例胸壁结核性脓肿的手术治疗总结

【摘要】 目的 总结胸壁结核性脓肿的手术经验。方法〓回顾性分析2000年1月~2013年12月在我院胸外科手术治疗的363例胸壁结核性脓肿病人的临床资料,所有患者均经过病理确诊。结果〓男性248例,女性115例,平均年龄32.3±4.7岁;左、右侧胸壁分别147例、175例,胸骨区41例;哑铃型137例,蟹足型52例,溃破型96例,混合型78例。273例切除了肉眼观和(或)影像观异常的肋骨,18例患者切除壁胸膜,113例采用肌瓣填充残腔。5例由于损伤胸廓内动脉中转开胸手术,全组无死亡病例。293例患者门诊随访16~35个月,一次性治愈率91.6%。25例(8.4%)复发脓肿,均经再次病灶清除术治愈。51例(14%)患者出现切口感染、裂开、脓肿或窦道形成,7例胸腔积液,4例肺结核播散,3例肺不张,1例皮下血肿,2例脓胸,均经保守治疗治愈。结论〓胸壁结核性脓肿手术总疗效满意,但切口问题较多。     

带蒂大网膜移植在难治性胸壁结核外科治疗中的应用

目的探讨在难治性胸壁结核手术中带蒂大网膜移植的临床应用及其疗效。方法回顾性分析2008年3月至2009年6月9例难治性胸壁结核患者临床资料,复发6例,巨大病灶3例。采用带蒂大网膜移植填塞残腔并缝合固定,术后持续绷带加压包扎2个月;随访9个月至2年。结果所有患者都一次手术治愈,术后继续抗结核治疗6—12个月,随访无一例复发。结论带蒂大网膜移植用于难治性胸壁结核患者的胸壁重建效果良好,可预防胸壁结核的复发。     

A surgical case of T-cell non-Hodgkin's lymphoma originating in the wall affected by chronic tuberculous empyema following artificial pneumothorax]

A 63-year-old male patient underwent artificial pneumothorax for right pulmonary tuberculosis 39 years ago, and thereafter suffered from chronic empyema, though asymptomatic. In December, 1989, he was found to have a 5 cm tumor in his right chest wall. The tumor grew to 15 cm in 2 weeks and was associated with severe pain. A chest CT revealed that the tumor of the chest wall corresponded to the area of the wall affected by empyema. The patient underwent full thickness resection of the chest wall including the tumor and the empyematous wall (20 x 20 cm) on March 7, 1990. The tumor was 11 x 8 x 7 cm large and had developed from the empyematous wall to the lateral side of chest wall. There was no invasion of the thoracic cavity by the empyema. The lesion was pathologically diagnosed as diffuse, large to intermediate T-cell non-Hodgkin's lymphoma. Postoperatively the patient was treated with radiotherapy and VEPA therapy, but the tumor metastasized to both lungs, and the patient died 161 days after surgery. The majority of cases of malignant lymphoma reported to have originated in empyematous chest walls have been of the B-cell type. The T-cell type is rare, and the present case is only the second case reported. Chest CT was an effective method of diagnostic imaging in this disease.     

腰骶段脊柱结核的手术治疗

目的：探讨腰骶段脊柱结核的手术治疗策略,及其疗效。方法：回顾性分析我科1997～2006年收治的48例腰骶段脊柱结核的病例资料,其中男29例,女19例;年龄22～58岁,平均38．8岁。术前神经功能按Frankel分级：B级1例,C级2例,D级13例,E级32例。腰骶角为18°±3．1°。根据病情采取不同的手术方式,所有患者术前给予4周以上的抗结核化疗,待血红蛋≥100gL,血沉及结核中毒症状改善后行手术治疗,其中一期前路病灶清除植骨融合内固定手术25例,一期后前联合入路手术14例,分期前后入路手术9例。结果：手术时间为130～240min,平均200min。失血量900～2000ml,平均1350ml。术中无大血管、硬膜损伤。术后并发症：慢性窦道形成1例,肠梗阻1例,逆行性射精1例,生殖股神经激惹1例。所有患者均获得随访,平均75．3个月（45-182个月）,术后6个月的植骨融合率为95．8％,术后1年融合率为100％。末次随访时,16例神经损伤者均获得一定好转,术后恢复为：D级2例,E级14例：腰骶角为24°±8．0°;无内固定松动,断裂。参见脊柱结核愈合标准,均获得治愈,无再发。结论：腰骶段脊柱结核因其特殊解剖结构,手术难度较大,只要术前充分准备,以正规抗结核化疗为基础,制定个体化手术方案,完全可取得很好的疗效。     

An innovative method of pediatric chest wall reconstruction using Surgisis and swinging rib technique

PurposeHerein, we describe a new surgical approach for chest wall reconstruction using a native supporting rib and Surgisis.MethodsA retrospective review of 3 cases from 2 tertiary pediatric health care centers presenting with chest wall defects in the neonatal period was performed. Perioperative data were collected.ResultsTwo chest wall deformities were diagnosed at birth (Poland syndrome and cleft sternum). One patient was diagnosed prenatally with a mediastinal mass. The first infant had absent ribs 2 through 9. He underwent chest wall reconstruction at 4 weeks of life because of difficulty weaning from ventilation related to paradoxical breathing. The hamartoma of the second asymptomatic patient was removed at 6 weeks. The third patient's V-shaped sternal defect encompassed through the upper two thirds of the sternum and was repaired at 6 months of age with intraoperative transesophageal echocardiogram monitoring. In all cases, Surgisis (collagen matrix) was used as an onlay patch. In 2 cases, a swinging rib acted supportive. Neither patient had intraoperative complications.ConclusionSurgisis is useful in pediatric chest wall reconstruction, particularly in combination with swinging ribs. The capacity for adaptation to the child's growth of this approach is crucial. Short-term safety is shown, but long-term assessment is required.     

Management of chylous leakage after axillary lymph node dissection in a patient undergoing breast surgery

A 71-year old woman who underwent a modified radical mastectomy for invasive ductal carcinoma of the left breast, developed postoperative chylous leakage. Though conservative management was uneffective, a direct surgical repair led to good results. Because the morbidity of a reoperation to the superficial chest wall is low, timely surgical treatment is therefore strongly recommended in cases of high output chylous leakage following a mastectomy.     

Necrotizing soft tissue infection of the chest wall

Necrotizing soft tissue infection (NSTI) of the chest wall is a relatively rare but highly lethal surgical infection which has received little attention in the medical and surgical literature. The data reported are based on a literature review, including a Medline database search, and search of existing bibliographies. Twenty well-documented cases of primary chest wall involvement by NSTI were found. Thirteen patients were male. Patients' ages ranged from 10 weeks to 78 years. Thirteen patients were postoperative (65%). The diagnosis was initially considered in only 3 of the postoperative cases, a cause of significant delays in surgical treatment. Among those who lived long enough for their wounds to close, 2 had secondary healing, 5 experienced delayed skin grafting over the granulating wound, and 1 had skin grafting combined with muscle transfer. Mortality was 60%. Chest wall NSTI is a rapidly spreading, highly lethal infection. A high index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.