CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核

目的：探讨CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核的临床价值。方法：将56例耐多药空洞性肺结核患者随机分为介入治疗组（28例）和单纯化疗组（28例）,均用3KmHPThZV/18PaVThZ化疗方案治疗,介入治疗组采用CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗,单纯化疗组单用抗结核药物治疗,观察疗效。结果：疗程结束时,介入治疗组痰菌阴转率（82.1%）、病灶吸收率（85.7%）、空洞闭合率（57.1%）明显高于单纯化疗组的46.4%、46.4%和21.4%（P〈0.05）。两组完成疗程时痰菌阴转者经0.5～1.0年随访,介入治疗组和单纯化疗组分别复发1例和2例,复发率分别为3.6%和7.1%,两组复发率比较,差异无统计学意义（P〉0.05）。介入治疗组无严重不良反应。结论：CT引导下经皮肺穿刺空洞内置中心静脉导管介入治疗耐多药空洞性肺结核具有加速痰细菌学阴转、病灶吸收和空洞闭合的作用,可促进症状改善,提高患者的生活质量。是一种安全、有效的介入方法,且无明显的并发症及毒副反应,值得临床推广应用。

Clinical study of interventional treatment under CT-guided percutaneous lung centesis indwelling central venous catheter administration in treatment of cavitary multi-drug resistant pulmonary tuberculosis

Objective： To evaluate the clinical treatment value of CT-guided percutaneous lung centesis indwelling central venous catheter administration in treatment of cavitary multi-drug resistant pulmonary. Methods： 56 patients with cavitary multi-drug resistant pulmonary tuberculosis were randomized 1 ∶1 to experimental group and control group. All patients received chemotherapy with 3KmHPThZV/18PaVThZ Meanwhile. 28 patients in experimental group received CT-guided percutaneous lung centesis indwelling central venous catheter administration combined with antituberculosis treatment, and 28 patients in control group received antituberculosis treatment alone. Clinical study of interventional treatment were observed. Results： At the end of the treatment, the sputum negative conversion rate was 82.1%, lesion absorption rate was 85.7%, and cavity closure rate was 57.1% in the experimental group, all of which were higher than those of the controls （46.4%, 46.4% and 21.4%）（P0.05）. The patients with the sputum negative conversion at the end of the treatment in two groups were followed up for 0.5-1.0 years, experimental group and control group were 1 case and 2 cases of recurrence, the recurrence rates were 3.6% and 7.1%. There was no statistically significant difference on recurrent rates in two groups （P0.05）. There were not severe adverse reactions observed in the experimental group. Conclusion： The interventional treatment under CT-guided percutaneous lung centesis indwelling central venous catheter administration in treatment of cavitary multi-drug resistant pulmonary is effective in improving sputum negative conversion ,lesion absorption and cavity closure. It is a reliable therapy method, and no obvious complication and adverse reaction are observed. It is worthy of promotion.