手术治疗短节段脊柱结核合并结核性脓胸的临床疗效分析

Clinical analysis of a short segment of spinal tuberculosis combined with tuberculous empyema

目的 探讨手术治疗短节段脊柱结核合并结核性脓胸的临床疗效.方法 回顾性分析2009年1月至2013年8月西安市结核病胸部肿瘤医院外科收治的74例短节段脊柱结核合并结核性脓胸患者.术前给予异烟肼（0.40 g静脉滴注,1次/d）、利福平（0.45 g/0.60 g口服,1次/d）、阿米卡星（0.40g静脉滴注,1次/d）、吡嗪酰胺（0.50 g口服,3次/d）或乙胺丁醇（0.75g口服,1次/d）治疗,至少2～4周以上,同时口服保肝药物治疗（复方甘草酸苷胶囊,2粒口服,3次/d）.行经胸同侧胸膜纤维板剥脱、脓胸病灶清除术,然后再行脊柱结核病灶清除、植骨融合及内固定手术,手术均一期完成.结果 74例患者病灶均临床治愈,未复发,6例患者术后形成皮肤窦道,经过异烟肼纱条多次换药,后均愈合.74例患者术后1～6周胸背部疼痛基本消失.结论 对于短节段脊柱结核合并结核性脓胸的患者,抗结核治疗至少2～4周后,尽早手术治疗,临床疗效较好,大部分可以临床治愈.

Objective To explore the clinical effect and operation for patients with a short segment of spinal tuberculosis combined with tuberculous empyema.Methods Clinical effects of the short segment of spinal tuberculosis combined with tuberculous empyema patients,which have been accepted in Xi＇an Tuberculosis and ThoracicTumor Hospital,were retrospectively analyzed from 2009 January to 2013 August.Preoperative anti-tuberculosis treatment was conducted with isoniazid （0.40 g intravenous qd）,rifampicin（0.4 g/0.60 g oral qd）,amikacin sulfate （0.40 g intravenous qd）,pyrazinamide（0.50 g oral bid） and ethambutol hydrochloride（0.75 g oral qd） at least 2-4 weeks,while also given oral hepatoprotective therapy （compound glycyrrhizin capsules,2 capsules,bid）.Pleura1 decortications and debridement of empyemas were performed for the first ipsilateral pleura1,and then debridement of spinal tuberculosis,bone graft fusion and internal fixation operation were performed.Seventy-four cases were all completed in one stage.Results All 74 cases in this group were cured without recurrence,except for 6 cases of postoperative sinus formed skin,which were healed after long term dressing with gauze of isoniazid injection.And all patients with the pain of the chest and back were disappeared after operation.Conclusion For patients with a short segment of spinal tuberculosis combined with tuberculous empyema,surgical operation should be performed as soon as possible and the clinical curative effect was good and most patients can be cured after antituberculous treatment were administered for at least 2-4 weeks.