363例胸壁结核性脓肿的手术治疗总结

doi:10.3969/j.issn.1009-976X.2015.06.002

摘要/Abstract

摘要： 【摘要】目的总结胸壁结核性脓肿的手术经验。方法〓回顾性分析2000年1月~2013年12月在我院胸外科手术治疗的363例胸壁结核性脓肿病人的临床资料,所有患者均经过病理确诊。结果〓男性248例,女性115例,平均年龄32.3±4.7岁;左、右侧胸壁分别147例、175例,胸骨区41例;哑铃型137例,蟹足型52例,溃破型96例,混合型78例。273例切除了肉眼观和(或)影像观异常的肋骨,18例患者切除壁胸膜,113例采用肌瓣填充残腔。5例由于损伤胸廓内动脉中转开胸手术,全组无死亡病例。293例患者门诊随访16~35个月,一次性治愈率91.6%。25例(8.4%)复发脓肿,均经再次病灶清除术治愈。51例(14%)患者出现切口感染、裂开、脓肿或窦道形成,7例胸腔积液,4例肺结核播散,3例肺不张,1例皮下血肿,2例脓胸,均经保守治疗治愈。结论〓胸壁结核性脓肿手术总疗效满意,但切口问题较多。

关键词: 胸壁, 冷脓肿, 手术, 结核

Abstract: 【Abstract】〓Objective〓To summarize the surgical experience of tuberculous abscess in the chest wall(TACW). Methods〓Retrospectively analyzed the clinical data of 363 patients with TACW treated by surgery in our hospital from January 2000 to December 2013. All patients were pathologically diagnosed. Results〓TACW occured in 248 male patients and in 115 female patients, with an average age of 32.3 ±4.7 years. There were 147 cases in the left side of chest wall, 175 cases in the right side of chest wall and 41 cases in the parasternal area. 137 dumbbell-shape abscess, 52 crab-shape abscess, 96 rupture abscess and 78 mixed-type abscess were formed. The lesions spread to ribs found by the naked eyes and (or) by imaging views were removed in 273 cases. The wall pleura was removed in 18 cases. The muscle flap was filled in the residual cavity in 113 cases. Five cases had to be converted to open-thoracic surgery due to the internal mammary artery injury. No deaths happened in 363 cases. 293 patients were followed up for 16 to 35 months, and the one-time cure rate was 91.6%. Twenty-five patients (8.4%) underwent the redebridement surgery due to recurrence of chest wall abscess and were cured by abscess. Of all cases, 51 (14%) cases experienced wound infection and dehiscence, abscess or fistula formation, 7 cases pleural effusion, 4 cases pulmonary tuberculosis dissemination, 3 cases pulmonary atelectasis, 1 case subcutaneous hematoma and 2 cases empyema.They were all cured by conservative treatment. Conclusion〓The total treatmenteffect of tuberculous abscess in the chest wall was satisfactory, but the operation incisions for chest wall abscess looked a difficult problem to deal with.

Key words: Chest wall, Cold abscess, Tuberculosis, Surgery

中图分类号:

R655.3

姜友定连贵勇陈穗劳燕萍伍静仪. 363例胸壁结核性脓肿的手术治疗总结[J]. 岭南现代临床外科, 2015, 15(06): 652-655.

Jiang Youding, Lian Guiyong, Chen Sui, Lao Yanping, Wu Jingyi. Surgical treatment of 363 cases of tuberculous abscess in the chest wall[J]. Lingnan Modern Clinics in Surgery, 2015, 15(06): 652-655.

参考文献

[1]Teo THP, Ho GH, Chaturverdi A, et al.Tuberculosis of the chest wall: unusual presentation as a breast lump［J］.[J].Singapore Med J, 2009, 50(3):e97-e99 [2]Shweta Sharma, R，K. Mahajan, V. P. Myneedu, et al..Primary Tubercular Chest Wall Abscess in a Young Immunocompetent Male［J］.[J].Case Rep Pulmonol, 2014, 2014:357456- [3]Faure E, Souilamas R, Riquet M, et al.Cold abscess of the chest wall:a surgical entity ［J］?[J].Ann Thorac Surg,, 1998,, 66( (4)):1174-1178 [4]Kim YT, Han KN, Kang CH, et al.Complete resection is mandatory for tuberculosis cold abscess of the chest wall[J].Ann Thorac Surg, 2008, 85(1):273-277 [5]Morris BS1, Maheshwari M, Chalwa A.Chest Wall tuberculosis:a review of CT appearance[J].The British Journal of Radiology, 2004, 77(917):449-457 [6] Paik HC, Chung KY, Kang JH, et al.Surgical treatment of tuberculosis cold ahscess of the chest wall［J］.[J].Yonsei Med J, 2002,, 43( (3)):309-314 [7] Keum DY, ?Kim JB, ?Park CK.Surgical treatment?of a?tuberculous?abscess?of the?chest wall［J］.[J].Korean J Thorac Cardiovasc Surg., 2012,, 45( (3)):177-182 [8]Kim DH, Choi CW.Chest wall abscess likely due to BCG vaccination in a child[J].Infection, 2009, 37(3):286-288 [9]Nonaka M, Arai T, Inagaki K, et al.Analysis of surgical treated chest wall tuberculosis［J］. [J].Nippon Kokyuukigeka Gakkaisi J Jpn Assoc Chest Surgery, 1991, 5:724-727 [10]Haruna A, Tomioka H, Ohtake Y, et al.Clinical analysis of 10 cases of chest wall tuberculosis［J］.[J].Kekkaku, 2005, 80( (2)):69-74 [11] Brown TS.Tuberculosis of the ribs［J］. [J].Clin Radiol, 1980, 31((6)):681-684 [12]Cho KD, Cho DG, Jo MS, et al.Current Surgical Therapy for Patients with Tuberculous Abscess of the Chest Wall[J].Ann Thorac Surg, 2006, 81(4):1220-1226 [13]张磊, 周衍慧.胸壁结核的诊断[J].中国防痨杂志, 2010, 32(2):101-103 [14] Goyal S, Sharma S, Bahl N.Role of FNAC in palpable?chest wall?lesions in developing country［J］.[J].Diagn Cytopathol., 2014, , 42( (8)):653-659 [15] YI HAN, QIUYUE ZHAO, DAPING YU, etc.Treatment of chest wall tuberculosis with transdermal ultrasound-mediated drug delivery［J］. [J].Exp Ther Med., 2015,, 9((4):): 1433-1437 [16]Deng B, Tan QY, Wang RW, etc.Surgical?strategy for tubercular?abscess?in the chest wall: experience of 120 cases［J］.[J].Eur J Cardiothorac Surg., 2012,, 41( (6):):1349-1352 [17]Hanadi Abid, Sonia Toujani, Jamel Ammar, et al.Chest swelling with adenopathy: Don’t forget tuberculosis[J].Respiratory Medicine CME, 2011, 4(1):47-49 [18]唐神结, 高文.临床结核病学［M］.北京:人民卫生出版社, [J]., 2011, :391- [19]Tanaka S, Aoki M, Nakanishi T, etc.Retrospective case series analysing the clinical data and?treatment?options of patients with a tubercular?abscess?of the?chest wall[J].Interact Cardiovasc Thorac Surg, 2012, 14(3):249-252