胸壁结核的诊断与治疗

目的　探讨胸壁结核的诊断与治疗。方法　对 68例胸壁结核诊治进行分析。根据脓肿穿刺确诊者 46例 ,依据病史、胸部X线及CT检查确诊者 13例 ,依据局部窦道久治不愈确诊者 9例。结果　所有病例均经手术治疗 ,单纯胸壁软组织结核病灶清除术 10例 ,肋骨切除加肌瓣填塞 5 0例 ,胸壁结核病灶清除加胸膜剥脱术 5例 ,局部胸廓成形术 3例。术后复发 5例 ,经再次手术而愈。结论　胸部CT检查对胸壁结核的诊断和治疗有重要的指导意义 ;预防术后复发是外科治疗的重点 ,正确设计切口是充分显露结核病灶的前提 ;清除病灶内结核性坏死组织和切除结核感染的肋骨、肋软骨以及覆盖的窦道上方的肋骨是彻底清创的关键 ;邻近肌瓣填塞创腔和术后加压包扎是消灭残腔的方法 :术前术后有效的抗结核治疗是外科治疗效果的保障

Diagnosis and Treatment of Thoracic Tuberculosis

Objective To explore the diagnosis and treatment of thoracic tuberculosis. Methods The materials of 68 cases with thoracic tuberculosis were analyzed retrospectively. 46 cases were diagnosed by abscess puncture. 13 cases were diagnosed according to disease history and the result of chest X-ray and CT examination. 9 cases were diagnosed by the representation that location sinus did not healed during a log time. Results All patients underwent surgical treatment, 10 patients with debridement of the pure chest wall soft tissue tuberculous focus, 50 patients with removal of ribs and muscle petal filling, 5 patients with debridement of chest wall tuberculous focus and pleurectomy, 3 patients with thoracoplasty. 5 cases underwent a second operation for recurrence. Conclusions It has an important guiding significance to undergo chest CT examination for the diagnosis and treatment of thoracic tuberculosis. The focus of surgical treatment is to prevent from postoperative recurrence. The right incision is a premise to fully appear tuberculous focus. To eliminate tuberculous tissue and resect the ribs, the costal cartilages infected with tuberculosis, and ribs covered tuberculous sinus is the key approach to quite debridement. Muscle petal filling and postoperative pressure bandage are good methods to exterminate remaining cavity. The preoperative and postoperative antituberculous treatment will ensure surgical curative effects.