术前超短程化疗联合手术治疗胸壁结核的疗效观察

目的探讨术前超短程抗结核方案联合手术治疗胸壁结核的安全性及疗效。方法回顾性分析2013年1月至2016年6月我院216例胸壁结核患者的临床资料,其中男121例、女95例,年龄4~74(35±15)岁。结果 216例胸壁结核患者术前抗结核时间(17.0±11.3)d,其中单纯胸壁结核术前抗结核时间(12.5±5.0)d,复合胸壁结核术前抗结核时间(19.4±12.9)d。经术前超短程抗结核治疗患者术后胸壁结核复发率为3.7%,接近或低于术前常规抗结核治疗复发率。结论术前超短程化疗联合手术治疗胸壁结核不会增加胸壁结核的复发率,且可有效缩短患者住院时间,提高患者治疗依从性。彻底病灶清除及全程抗结核治疗是治愈胸壁结核的关键。     

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。     

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。     

影响胸腰椎结核患者术后复发的危险因素分析

目的分析影响胸腰椎结核患者术后复发的危险因素。方法选取2010-01-2016-01实施一期后路病灶清除、植骨融合内固定术治疗的胸腰椎结核患者230例,术后随访1年,其中复发30例,未复发200例,对比复发与未复发患者临床资料,分析复发特点、复发原因、复发影响因素及预防措施。结果复发患者胸壁或腰椎肿块伴轻微胸痛,形成脓肿有波动感,部分局部伤口破溃迁延不愈,病灶清除不彻底、耐药性结核菌株出现、非活性异物过多放置、内固定松动失效、不正规化疗、长期营养不良是复发的主要原因。多因素Logistic回归分析结果显示,术前抗结核治疗时间短、未达术后制动时间、手术清除病灶不彻底、术后未规范治疗是导致术后复发的独立危险因素(P0.05)。结论胸腰椎结核患者术前抗结核治疗时间短、未达术后制动时间、手术清除病灶不彻底、术后未规范治疗是导致术后复发的独立危险因素,临床医师应给予足够重视。     

120例胸壁结核外科治疗体会

目的探讨胸壁结核外科治疗的方法及临床疗效。方法 120例胸壁结核均在气管内插管全身麻醉下施行病灶清除术,术前正规抗结核治疗2周以上。有窦道的33例逐一切开,切除有病变的肋骨、肋软骨、胸骨,游离带蒂肌瓣填充残腔,络合碘液及生理盐水冲洗,置放链霉素粉或异烟肼液,伤口加压包扎3周以上,术后继续抗结核治疗6～9个月。结果全组围手术期无死亡病例。113例切口Ⅰ期愈合7,例伤口裂开,局部换药后Ⅱ期愈合。全部治愈出院,平均随访1年（3个月～2年）,复发3例,经再次手术治愈。结论应用病灶清除术行胸壁结核的外科治疗是安全可行的。     

外科诊治甲状腺结核的方法选择(5例报道及文献复习)

目的探讨甲状腺结核诊断和治疗的技术选择,以及临床分型和流行病学特点。方法回顾性总结我们收治的5例甲状腺结核的临床资料,并结合相关文献分析甲状腺结核的疾病特点、诊治要点、误诊原因和手术方式。结果 所有患者术前均误诊,术中病理确诊2例,术后病理确诊3例。其中4例为干酪型,1例为增生型,均属慢性甲状腺结核,无急性甲状腺结核病例。手术根据病灶特点切除甲状腺一叶或大部(3例),不能切除者清除坏死组织后局部置药(2例)。术后行正规抗结核治疗6~8个月。所有患者均治愈。分别获随访2、5、7、8及15年,无复发。结论 甲状腺结核一般术前诊断困难,治疗宜根据甲状腺结核的病理类型、病灶特点和伴发疾病而定,选择手术切除、清创置药、局部注药或全身抗结核治疗。增生型可手术切除,干酪型若切除困难,可选择清除病灶,局部置药。     

CT引导下经皮微创治疗脊柱结核的近期疗效

目的总结CT引导下经皮微创治疗脊柱结核的近期临床效果。方法 2005年1月至2012年12月对82例脊柱结核患者采用CT引导下行经皮病灶清除,病灶置管,抗结核药物灌注冲洗引流。记录手术时间、术中出血量、住院时间等指标。术后随访时采用Oswestry功能障碍指数评分并参照张西峰等改良的脊柱结核治愈标准进行疗效评估。结果该组患者均顺利手术。复查均未发现结核复发,术后3个月ESR、CRP恢复至正常。所有患者均达到临床治愈,有神经功能损害者均完全恢复,Oswestry功能障碍指数治疗前后比较差异有统计学意义。治疗前后影像学、症状体征改变终末随访时均有明显改善。结论微创治疗疗效好,具有操作简便、安全、创伤小,治疗费用低等优点,对活动期脊柱结核的临床效果好,是理想的微创手术方法。     

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。     

肝脏结核手术治疗八例报告

目的 探讨肝脏结核的临床特征及手术方式。方法 对肝脏结核8例病人的临床表现、病灶部位、诊断及治疗方式进行分析。结果 本组病人术前无未做出明确诊断,手术方式以病灶切除（5例）及部分切除加开窗引流（3例）为主,术后病理学检查均证实为肝脏结核。结论 手术切除及抗结核治疗是肝脏结核的主要治疗手段。     

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.     

Total hip arthroplasty for active tuberculosis of the hip

Total hip arthroplasty (THA) has been used as a successful form of treatment in patients with long-standing tuberculosis, but it is unclear whether THA should be performed in patients with current infection. We performed THA in six patients with advanced active tuberculosis of the hip from 2002 to 2006. Tuberculosis was confirmed in all cases by histological examination. All patients were treated with antituberculous medications for at least two weeks followed by thorough debridement and THA. Antituberculous medications were administered postoperatively for at least 12 months. The duration of postoperative follow-up was an average of 49 months. No reactivation of the infection was detected in our series. Using the Harris hip score system, five of the patients were classified as excellent and one as good. THA in advanced active tuberculosis of the hip is a safe procedure providing symptomatic relief and functional improvement. Thorough debridement of infected tissues and postoperative antituberculous therapy are the keys to lowering the potential risk of reactivation of tuberculosis.     

Total hip replacement in old tuberculosis: A report of 14 cases

We treated 14 patients with a cemented total hip replacement for old tuberculosis on an average 43 years after the onset of the coxitis. Nine patients were not given any antituberculous treatment, whereas in 5 patients treatment with antituberculous drugs was administered postoperatively for 6 to 12 months. The duration of postoperative follow-up was on an average 8 (5-10) years. Using the Mayo hip scoring system, 8 of the patients were classified as excellent or good, 3 as fair, and 3 as poor. The poor results were in 2 cases due to aseptic loosening of the prosthesis and infection in 1. None of the patients showed reactivation of the tuberculosis.     

Scrofuloderma neck with chest wall abscess

Cutaneous tuberculosis (TB) is among the uncommon varieties of tuberculosis but it is also on the rise, commensurate with the general resurgence of the disease. A case of scrofuloderma of neck with tuberculous abscess of anterior chest wall is, hereby, reported. The patient presented with a non-healing ulcer of neck with swelling of anterior chest wall, which responded to antituberculous treatment. This complication of scrofuloderma neck is very rare and should be kept in mind in the differential diagnosis of such lesions.     

Total hip replacement in old tuberculosis. A report of 14 cases

We treated 14 patients with a cemented total hip replacement for old tuberculosis on an average 43 years after the onset of the coxitis. Nine patients were not given any antituberculous treatment, whereas in 5 patients treatment with antituberculous drugs was administered postoperatively for 6 to 12 months. The duration of postoperative follow-up was on an average 8 (5-10) years. Using the Mayo hip scoring system, 8 of the patients were classified as excellent or good, 3 as fair, and 3 as poor. The poor results were in 2 cases due to aseptic loosening of the prosthesis and infection in 1. None of the patients showed reactivation of the tuberculosis.     

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.     

Tuberculosis following kidney transplantation

Morbidity of tuberculosis following kidney transplantation is about 1% (14/1719 kidney transplantations). All cases occurred within 1 year after transplantation; surprising was the relative high incidence in patients from outside Central Europe. Four patients with lack of clinical symptoms in whom the diagnosis was made by routine X-ray films of the chest survived after immediate therapy while five of ten patients with miliary tuberculosis died although proper treatment was performed. In cases of fever not caused by rejection or in pneumonia resistant to common antibiotics prophylactic antituberculous therapy should be considered even if microbiological evidence is not yet confirmed.     

Acute respiratory distress syndrome caused by tuberculosis

The adult respiratory distress syndrome (ARDS) is rarely due to tuberculosis. Two new cases are reported here. Both were female patients, aged 33 and 41 years. The first, of North African origin, was admitted for epigastralgia, hyperpyrexia and intestinal problems. She underwent an exploratory laparotomy, which only showed oedematous mesenteries. Hepatic and lymph node biopsies revealed an ongoing tuberculosis. On the 4th postoperative day, she developed ARDS. Despite an initial period of improvement after proper treatment (antituberculous drugs, steroids, positive pressure ventilation) had been started, she died 27 days later. In the other patient, smoker and alcoholic, the diagnosis of tuberculosis relied only on bacterial culture of various excretions. She also died after 8 days of treatment. In both patients, the symptoms were atypical. The febrile non cardiogenic pulmonary oedema of sudden onset masked the typical miliary mottling pattern on chest X-rays. The life-threatening character of this condition requires that rapid histological studies are carried out to obtain an early diagnosis. Indeed, the precociousness of appropriate treatment seems to be the essential element of the prognosis.     

Cementless total hip arthroplasty for the treatment of advanced tuberculosis of the hip

The question of whether a total hip arthroplasty (THA) should be attempted in a patient with a current or previous tuberculosis infection continues to cause controversy. The goal of this study was to evaluate the clinical result of cementless THA for the treatment of advanced tuberculosis of the hip. Eight patients with advanced tuberculosis of the hip treated by cementless THA were retrospectively analyzed. None of the patients had draining sinus preoperatively. For patients with a confirmed preoperative diagnosis of tuberculosis and elevated C-reactive protein and erythrocyte sedimentation rate, antituberculous medication was prescribed for at least 2 weeks preoperatively. Inflamed soft tissues and destroyed bones were completely curetted out intraoperatively. All 8 patients received 1-stage cementless THA after thorough debridement. Antituberculous medications were prescribed for all patients for the first 6 months postoperatively. No patient experienced wound-healing complications. Mean Harris Hip Score was 35 (range, 30-43) preoperatively and 91 (range, 87-95) at last follow-up. At an average 46-month follow-up (range, 34-59 months), no reactivation of tuberculosis was detected. All 8 patients revealed stability by bone ingrowth on both the socket and femoral stem. Cementless THA is a safe and effective procedure for advanced tuberculosis of the hip. With thorough debridement followed by a complete course of antituberculous chemotherapy, active tuberculous infection should not be considered a contraindication for THA.