88例成人胸椎结核外科治疗分析

Analysis of surgical treatment for 88 adult thoracic tuberculosis patients

目的回顾性分析陕西省结核病防治院成人下胸椎结核（T4--T10）患者手术方法及疗效，探讨经胸腔入路和胸膜外入路治疗胸椎结核术式选择的适应证。方法选取2010年3月至2015年12月，陕西省结核病防治院经手术治疗并获得随访的88例成人胸椎结核患者作为研究对象。研究对象术后平均随访21个月（18--24个月）。根据患者病变范围及一般状况分为A组（68例）和B组（20例），A组采用经胸腔入路病灶清除，植骨融合内固定术；B组采用经胸膜外病灶清除，植骨融合内固定术。结果手术时间：A组为2．5h，B组为3．5h。出血量：A组平均约600ml，B组平均约1000ml。随访88例患者自体髂骨或肋骨植骨均骨性融合。结论成人下胸椎结核的术式选择应根据患者一般状况、病变部位及范围而定，经胸腔入路创伤相对较小，手术时间短，出血量少；如无严重脊柱畸形、胸腔粘连、肺部疾病导致肺功能差，而难以耐受开胸手术的患者，可以优先选择经胸腔入路病灶清除，植骨融合内固定术。

Objective To retrospectively analyze the operational manner and efficacy of surgery of adult thoracic tuberculosis （TB） in Tuberculosis Hospital of Shaanxi Province, and to explore the indications for thoracic surgery and external pleural surgery. Methods A total of 88 patients undergone surgery and followed up from Tuberculosis Hospital of Shaanxi Province between March 2010 and December 2015 were selected, they were followed up from 21 to 24 months with mean of 21 months. Based on the lesions and general condition, patients were divided into group A （68 cases, undergone thoracic surgery with interbody fusion and internal fixation） and group B （20 cases, undergone external pleural surgery with interbody fusion and internal fixation）, Group A with chest lesions cleared into the road, the bone graft fusion and internal fixation; Group B outside the pleural lesions cleared, bone graft fusion and internal fixation. Results Duration of operation was 2.5 hours in group A, and that in group B was 3.5 hours. And the average of operative hemorrhage was 600 ml in group A, 1000 ml in group B, respectively. All the 88 follow-up patients were autogenous iliac or rib graft bony fusion. Conclusion Operational manner for adult thoracic TB should be decided based on the general condition and location and extent of lesions. Thoracic surgery was showed as fewer traumas, shorter time of operation and less hemorrhage. Thoracic surgery with interbody fusion and internal fixation might be preferred for adult thoracic TB patients who are difficult to tolerate thoracotomy operation and without severe spinal deformity, pleural adhesion or poor pulmonary function caused by pulmonary diseases.