术前超短程化疗联合手术治疗胸壁结核的疗效观察
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摘要
目的探讨术前超短程抗结核方案联合手术治疗胸壁结核的安全性及疗效。方法回顾性分析2013年1月至2016年6月我院216例胸壁结核患者的临床资料,其中男121例、女95例,年龄4~74(35±15)岁。结果 216例胸壁结核患者术前抗结核时间(17.0±11.3)d,其中单纯胸壁结核术前抗结核时间(12.5±5.0)d,复合胸壁结核术前抗结核时间(19.4±12.9)d。经术前超短程抗结核治疗患者术后胸壁结核复发率为3.7%,接近或低于术前常规抗结核治疗复发率。结论术前超短程化疗联合手术治疗胸壁结核不会增加胸壁结核的复发率,且可有效缩短患者住院时间,提高患者治疗依从性。彻底病灶清除及全程抗结核治疗是治愈胸壁结核的关键。
Objective To investigate the safety and efficacy of preoperative ultra-short-course chemotherapy combined with surgical treatment of chest wall tuberculosis. Methods The clinical data of 216 patients with chest wall tuberculosis from January 2013 to June 2016 in our hospital were retrospectively analyzed, including 121 males and 95 females with an average age of 35±15 years(range, 4-74 years). Results All patients were treated with anti-tuberculosis drugs for 17.0±11.3 days preoperatively, including 12.5±5.0 days in simple chest wall tuberculosis and 19.4±12.3 days in combined chest wall tuberculosis. The postoperative recurrence rate of chest wall tuberculosis was 3.7%, which was close to or lower than that of routine preoperative antituberculous therapy in patients with ultra-short-course anti-tuberculosis treatment before surgery. Conclusion Preoperative ultra-short-course chemotherapy combined with surgical treatment for chest wall tuberculosis will not increase the recurrence rate of chest wall tuberculosis, and can effectively shorten the hospital stay. Timely adjustment of anti-tuberculosis chemotherapy based on thorough debridement, postoperative drugs,not the preoperative drugs, is the key to reinforce the surgical outcome.
Objective To investigate the safety and efficacy of preoperative ultra-short-course chemotherapy combined with surgical treatment of chest wall tuberculosis. Methods The clinical data of 216 patients with chest wall tuberculosis from January 2013 to June 2016 in our hospital were retrospectively analyzed, including 121 males and 95 females with an average age of 35±15 years(range, 4-74 years). Results All patients were treated with anti-tuberculosis drugs for 17.0±11.3 days preoperatively, including 12.5±5.0 days in simple chest wall tuberculosis and 19.4±12.3 days in combined chest wall tuberculosis. The postoperative recurrence rate of chest wall tuberculosis was 3.7%, which was close to or lower than that of routine preoperative antituberculous therapy in patients with ultra-short-course anti-tuberculosis treatment before surgery. Conclusion Preoperative ultra-short-course chemotherapy combined with surgical treatment for chest wall tuberculosis will not increase the recurrence rate of chest wall tuberculosis, and can effectively shorten the hospital stay. Timely adjustment of anti-tuberculosis chemotherapy based on thorough debridement, postoperative drugs,not the preoperative drugs, is the key to reinforce the surgical outcome.
引文
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2Teo TH, Ho GH, Chaturverdi A, et al. Tuberculosis of the chest wall:unusual presentation as a breast lump. Singapore Med J, 2009,50 (3):e97-e99.
3彭卫生,王英年,肖成志.主编.新编结核病学.第2版.北京:中国医药科技出版社, 2003. 230-231.
4李亮,李琦,许绍发,等.主编.结核病治疗学.第1版.北京:人民卫生出版社, 2013.314-316.
5Han YI, Zhao Q, Yu D, et al. Treatment of chest wall tuberculosis with transdermal ultrasound-mediated drug delivery. Exp Ther Med, 2015, 9(4):1433-1437.
6王伟,金明华,侯庆宝,等.胸壁结核的外科治疗.中国胸心血管外科临床杂志, 2006, 13(2):139-139.
7郭岱.脊柱结核并截瘫患者术前不同化疗天数与临床疗效的相关研究.中南大学, 2010.
8郑俊儒.脊柱结核术前不同化疗时间对手术安全性及预后的研究.新疆医科大学, 2016.
9钱勇,杨继承,袁跃西. 120例胸壁结核外科治疗体会.中国现代手术学杂志, 2011, 15(5):364-365.
10黄喜峰,韦鸣,廖勇,等. 54例胸壁结核的外科治疗经验回顾.中国防痨杂志, 2011, 33(4):247-248.
11金锋,王成,刘景亮,等.外科治疗复发性胸壁结核61例报告.中国现代医学杂志, 2006, 16(16):2542-2543.
12王刚,刘武新,周旭东,等.外科治疗373例胸壁结核的临床分析.临床肺科杂志, 2007, 12(2):134-135.
13 刘丽君,张维民,王福臣,等.胸壁结核术后复发原因的探讨.中国防痨杂志, 2005, 27(4):272-273.
2Teo TH, Ho GH, Chaturverdi A, et al. Tuberculosis of the chest wall:unusual presentation as a breast lump. Singapore Med J, 2009,50 (3):e97-e99.
3彭卫生,王英年,肖成志.主编.新编结核病学.第2版.北京:中国医药科技出版社, 2003. 230-231.
4李亮,李琦,许绍发,等.主编.结核病治疗学.第1版.北京:人民卫生出版社, 2013.314-316.
5Han YI, Zhao Q, Yu D, et al. Treatment of chest wall tuberculosis with transdermal ultrasound-mediated drug delivery. Exp Ther Med, 2015, 9(4):1433-1437.
6王伟,金明华,侯庆宝,等.胸壁结核的外科治疗.中国胸心血管外科临床杂志, 2006, 13(2):139-139.
7郭岱.脊柱结核并截瘫患者术前不同化疗天数与临床疗效的相关研究.中南大学, 2010.
8郑俊儒.脊柱结核术前不同化疗时间对手术安全性及预后的研究.新疆医科大学, 2016.
9钱勇,杨继承,袁跃西. 120例胸壁结核外科治疗体会.中国现代手术学杂志, 2011, 15(5):364-365.
10黄喜峰,韦鸣,廖勇,等. 54例胸壁结核的外科治疗经验回顾.中国防痨杂志, 2011, 33(4):247-248.
11金锋,王成,刘景亮,等.外科治疗复发性胸壁结核61例报告.中国现代医学杂志, 2006, 16(16):2542-2543.
12王刚,刘武新,周旭东,等.外科治疗373例胸壁结核的临床分析.临床肺科杂志, 2007, 12(2):134-135.
13 刘丽君,张维民,王福臣,等.胸壁结核术后复发原因的探讨.中国防痨杂志, 2005, 27(4):272-273.