手术治疗复发性胸壁结核的效果评价

Evaluation of surgical treatment of the recurrent chest wall tuberculosis

目的评价手术治疗复发性胸壁结核的临床效果。方法回顾性分析我院2013年1月~2017年6月收治的96例复发性胸壁结核患者的历例资料,统计分析手术治疗后原切口和非原切口的愈合及复发情况,并将患者病灶表现与手术效果进行皮尔逊相关分析。结果从复发部位看,非原切口复发24例(25%),原切口复发72例(75%),两者差异有统计学意义(χ~2=65.68,P<0.001);从性别上看,原切口复发男性50例(69.44%),女性22例(30.56%),两者差异无统计学意义(χ~2=0.78,P>0.05)。96例复发性胸壁结核患者经手术治疗后,甲级切口愈合90例(93.75%),延期愈合6例(6.25%);术后随访1年,仅在原切口的结核病灶复发4例,6例切口延期愈合患者经再次手术治疗后均治愈。在手术治疗复发性胸壁结核的疗效中,术后近期及随访1年后为甲级愈合与胸壁结核CT分型为哑铃型的呈负相关,与原切口复发部位和疼痛呈负相关;延期愈合与胸壁结核CT分型为哑铃型呈正相关,与原切口复发部位和疼痛呈正相关。结论针对复发性胸壁结核,手术治疗能够直接清除病灶,同时采用抗痨及抗感染处理,治疗效果良好。

Objective To inquire into the clinical effect of reoperation for recurrent chest wall tuberculosis.Methods 96 patients with recurrent chest wall tuberculosis treated in our hospital from January 2013 to June 2017(male 65 cases,female 31 cases)were included in the present study.The healing and recurrence of the original incision and the non original incision after operation treatment,and the performance of the patient's lesions and the effect of the surgery were analyzed by Pearson correlation analysis.Results From the recurrence site,there were 24 cases(25%)with no original incision of recurrent chest wall tuberculosis and that of the original incision 72 cases(75%),the difference was statistically significant(X2=65.68,P<0.001).There were 50 male patients(69.45%)and 22 females(30.55%)with recurrent incision,the difference was no statistically significant(X2=0.78,P>0.78).96 patients underwent surgical treatment,grade A incision healing in 90 cases(93.75%),delayed healing in 6 cases(6.25%),follow-up for one year after the operation,only in the original incision of tuberculosis focal recurrence of 4 cases,6 cases of delayed healing patients after reoperation were cured.In the treatment of recurrent thoracic wall tuberculosis,there was a negative correlation between the recent postoperative and 1 year follow-up grade A healing and the CT classification of thoracic wall tuberculosis as dumbbell type,and the recurrence and pain of the original incision.The delayed healing was positively correlated with the CT typing of thoracic wall tuberculosis as dumbbell type and with the recurrence and pain of the original incision.Conclusion For recurrent chest wall tuberculosis,surgical treatment can directly remove lesions,and use of anti-infective and anti-tuberculosis treatment as well,the clinical effect is good.