脊柱结核合并血行播散型肺结核的手术治疗

Surgical treatment of spinal tuberculosis combined with hematogenous pulmonary tuberculosis

目的探讨脊柱结核合并血行播散型肺结核的手术治疗时机、手术方案及其疗效。方法选择1999年1月至2012年5月我院收治脊柱结核合并血行播散型肺结核患者23例，男14例，女9例；年龄2～80岁，平均40．5岁：累及连续节段者18例，累及椎体41个，平均2．3个。其中颈胸段结核1例，胸椎结核6例，胸腰段结核2例，腰椎结核7例．腰骶段结核2例：累及跳跃节段者5例，l例累及T10／11，L2／3，1例T2，4．1例T11／12，洲5，1例T10。L2／3，1例1.7-L1，L4／5；术前抗结核治疗时间1～8个月，平均3．7个月；单纯后路手术9例，单纯前路手术4例，前后路联合手术9例．分期手术1例。结果手术时间120-360min，平均190min。术中失血量200～2000ml，平均680ml。术中出现髂内静脉损伤2例。术后并发症：切口窦道形成1例，切口积液2例，肺部感染2例。随访24～120个月，平均36-3个月．脊柱结核获得治愈，无复发。2例患者于术后2年取出内固定。3例神经功能障碍患者末次随访时Asia分级均达到E级。结论脊柱结核合并血行播散型肺结核患者术前抗结核治疗时间需适当延长，以3个月为宜．根据患者一般状况、病变及脓肿部位灵活选择前路，后路或联合人路手术方案，及时处理术后并发症，坚持18．24个月化疗方案，可以取得较好效果。

Objective To investigate the effect, surgical procedure duration and surgical methods of spinal tuber culosis combined with hematogenous pulmonary tuberculosis. Methods Twenty-three cases of spinal tuberculosis com bined with hematogenous pulmonary tuberculosis were admitted to Beijing chest hospital from January 1999 to May 2012. There were 14 males and 9 females, with an average age of 40.5 years （range 2-80 years）. The 18 patients involved con secutive segments including 41 vertebrae, with an average of 2.3 vertebra. involved segments included： 1 cortical-thoracic segment, 6 thoracic segments, 2 thoracic-lumbar segments, 7 lumbar segments, 2 lumbar-sacral segments. The 5 patients had un-consecutive segments included： 1 T10/ll,L2/3,1 T2,4,1 T11/12,IA/5,1 T10,L2/5,1TT-L1 ,IA/5. The mean time of anti-tuberculosis chemotherapy pre-operation was 3.7 months,ranged from 1-8 months. The surgical methods included 9 single posterior surgeries, 4 single anterior surgeries, 9 one stage anterior-posterior surgeries, 1 two-stage surgery. Results The operation duration ranged from 120 min to 360min, with 190rain in average. The blood loss ranged from 200 to 2000ml, with 680ml in average. The internal ihac vein Two was injured intraoperatively in 2 patients.The postoperative complications included： sinus tract in 1 case, incision hydropsy in 2 cases, pulmonary infection in 2 cases. The follow-up duration was 24 to 120 months, with 36.3 months in average. At the final follow-up, the spinal tuberculosis was cured, no recurrence were found. And 3 cases combined with neurological dysfunction that was improved in ASIA score to E level. The internal fixations were taken out two years after surgery in 2 patients. Conclusion It is appropriate that pre-opera- tion anti-tuberculosis chemotherapy should be extended to 3 months in spinal tuberculosis combined with hematogenous pulmonary tuberculosis. The 18-24 months anti-tuberculosis chemotherapy should be insisted. The operation approach should be chosen based on the patient＇s general conditions, the site of the tuberculosis foci, the location of the abscess andpostperative complications should be treated promptly.