经皮穿刺置管引流结合抗痨治疗结核性髂腰肌脓肿

Percutaneous catheter drainage combined with antituberculosis chemotherapy in the management of tuberculous iliopsoas abscesses

目的 评价B超引导下经皮穿刺置管引流 (PCD)结合全身抗痨治疗结核性髂腰肌脓肿的适应证和临床效果。 方法 回顾分析 1997年 2月～ 2 0 0 1年 10月PCD治疗的结核性髂腰肌脓肿 36例 (4 8个脓肿 ) ,影像学证实脊柱结核者 34例 ,椎体破坏轻 ,不伴严重后凸畸形、椎体不稳或截瘫。抗结核化疗时间 1年～ 1 5年。 结果 引流时间 8天～ 30天 ,平均14天 ,脓肿首次治愈率 85 4 % (4 1 4 8) ,失败 7个 ,3个脓肿复发经再次置管引流后缓解 ,3例 (4个脓肿 )椎体病变加重 ,予以切开手术治疗。其中 2 5例随防 14月～ 5年 ,平均 4 0月 ,远期治愈率 92 % (2 3 2 5 ) ,2例复发 ,予以手术治疗。未见病变椎体高度丢失或严重后凸畸形。未见严重并发症。 结论 脊柱结核合并髂腰肌脓肿 ,若椎体破坏轻、无椎管受累、以脓肿病变为主 ,B超引导下PCD结合抗痨化疗是一种安全、有效、简单的治疗方法。

Objective To evaluate the indications and efficiency of ultrasonography guided percutaneous catheter drainage (PCD) combined with antituberculosis chemotherapy in the management of tuberculous iliopsoas abscesses. Methods A retrospective analysis of 36 patients with tuberculous iliopsoas abscesses (48 lesions) treated by PCD from February 1997 to October 2001 was made. Thirty-four patients were confirmed imagiologically as spine tuberculosis, without severe vertebral involvement, vertebral instability, severe kyphosis or paraplegia. The duration of antituberculosis chemotherapy ranged 12～18 months. Results The mean duration of drainage was 14 days (range, 8～30 days). Out of the 48 lesions, 41 lesions (85.4%) were cured on one session, 3 lesions were found recurrence and cured by second PCDs, and 4 lesions were found exacerbation and treated by incision and drainage. Follow-up for 14 months～5 years (mean, 40 months) in 25 patients revealed a long-term cure rate 92% (23 of 25) and recurrence in 2 patients which were further treated by operations. No vertebral compression, severe kyphosis or other complications were encountered in this study. Conclusions Ultrasonography guided PCD combined with antituberculosis chemotherapy is a simple, safe and effective alternative in the management of tuberculous iliopsoas abscesses, provided there are no severe vertebral damage or vertebral canal involvement.