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。
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 was91.6%. 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.
出处
《岭南现代临床外科》
2015年第6期652-655,共4页
Lingnan Modern Clinics in Surgery
关键词
胸壁
结核
冷脓肿
手术
Chest wall
Tuberculosis
Cold abscess
Surgery
