215例胸椎结核外科治疗的回顾性分析

The retrospective analysis of surgical treatment in 215 cases with thoracic spinal tuberculosis

目的探讨胸椎结核的外科治疗经验及手术方式选择。方法回顾性分析2004年1月至2014年12月接受手术治疗的215例胸椎结核患者的临床资料。其中男117例，女98例；年龄8～74岁，平均（38．0±4．6）岁；病史2～37个月，平均（8．0±3．7）个月。根据患者情况采用不同手术方式：行肋骨横突切除胸膜外病灶清除术49例；经胸腔内病灶清除术104例，其中选择性地采用胸腔镜辅助小切口行胸椎结核病灶清除术27例；下胸椎结核患者因脓肿向腰大肌等处流注而行复合术式62例。结果全组无一例患者围手术期死亡，215例患者中一次手术治愈者207例；复发者8例，经过再次手术治愈。行肋骨横突切除胸膜外病灶清除术49例，一次手术治愈46例；经胸腔内病灶清除术104例，其中选择性地采用胸腔镜辅助小切口行胸椎结核病灶清除术27例，一次手术治愈102例；下胸椎结核患者因脓肿向腰大肌等处流注而行复合术式62例，一次手术治愈59例。9例切口愈合不良，经过换药护理后治愈。4例出院后1～4个月间出现同侧切口附近脓肿，经过脓肿病灶清除术治愈，其余患者均恢复良好。结论在胸椎结核的治疗过程中，手术治疗仍然有不可替代的作用，根据病变的部位、范围及患者的身体状况选择恰当的手术方式能够取得良好的治疗效果。

Objective To explore the experiences and operative procedure choice for surgical treatment of thoracic spinal tuberculosis. Methods The clinical data from 215 consecutive cases with thoracic spinal tuberculosis received surgical treatment were retrospectively analyzed during January 2004 to December 2014. There were 117 males and 98 females, average age （38. 0±4.6） ranged from 8 to 74 years old, average medical history time （8.0± 3.7） ranged from 2 to 37 months. Different surgical approaches were performed according to situation of patients： extrapleural focus debridement via rib transverse process resection in 49 cases, focus debridement via intrathoracic in 104 cases including thoracic vertebrae focus debridement by selective video-assisted thoracoscopic surgery in 27 cases and combined approaches due to lower thoracic vertebrae tuberculosis with abscess psoas major in 62 cases. Results No perioperative death occurred in all patients. Of 215 cases, 207 cases were cured in one operation, and recurrence in 8 cases which was cured by reoperation. Forty six cases were cured in one operation among 49 cases performed by extrapleural focus debridement via rib transverse process resection. 102 cases were cured in one operation among 104 cases performed by focus debridement via intrathoracic including 27 cases performed by thoracic vertebrae focus debridement via selective video-assisted thoracoscopic surgery. Fifty nine cases were cured in one operation among 62 cases performed by combined approaches due to lower thoracic vertebrae tuberculosis with abscess psoas major. 9 cases with poor wound healing were cured by dressing change. Four cases with abscess formation after discharge one to four months were cured by focus debridement. The others patients recovered well. Conclusion In the treatment of thoracic tuberculosis, surgical treatment still has an irreplaceable role. According to the location and range of the lesion and the patient＇s physical condition, the appropriate surgical procedure selected can get good treatment outcome.