Tanaka Satona, Aoki Minoru, Nakanishi Takao, Otake Yosuke, Matsumoto Masataka, Sakurai Toshiyasu, Tada Kimihide, Ikeda Akihiko
Department of Thoracic Surgery, Nishi-Kobe Medical Center, Nishi-ku, Kobe, Japan.
Interact Cardiovasc Thorac Surg. 2012 Mar;14(3):249-52. doi: 10.1093/icvts/ivr113. Epub 2011 Dec 18.
The tubercular abscess of the chest wall remains one of the differential diagnoses of a chest wall tumour, and the management strategy is controversial. We reviewed the medical records of 22 patients treated at our institution. Two patients were managed by antitubercular medications alone; eight patients were managed by medication and open drainage. Five patients underwent open drainage with subsequent radical surgery at a constant interval of time, and the mean duration between open drainage and radical surgery was 9.8 weeks (range, 3-12). Seven patients underwent radical surgery without prior open drainage. Five patients required rib resections, and curettage of infected pleural peel was necessary in 5 patients. Antitubercular drugs were administered basically for more than 6 months regardless of surgical management, including for more than 1 month prior to radical surgery. Postoperative empyema was seen in 1 patient after radical surgery. The mean follow-up duration was 32.8 months (range, 3-100), and there was no recurrence. Complete resection of the tubercular abscess with sufficient antitubercular therapy resulted in a satisfactory outcome. Antitubercular therapy with or without open drainage can be a viable choice.
胸壁结核性脓肿仍是胸壁肿瘤的鉴别诊断之一,其治疗策略存在争议。我们回顾了在我院接受治疗的22例患者的病历。2例患者仅接受抗结核药物治疗;8例患者接受药物治疗及开放引流。5例患者接受开放引流,随后在固定时间间隔进行根治性手术,开放引流与根治性手术之间的平均时长为9.8周(范围3 - 12周)。7例患者未先行开放引流即接受根治性手术。5例患者需要进行肋骨切除,5例患者需要刮除感染的胸膜剥脱组织。无论手术治疗方式如何,抗结核药物基本使用超过6个月,包括在根治性手术前使用超过1个月。根治性手术后1例患者出现术后脓胸。平均随访时长为32.8个月(范围3 - 100个月),无复发。通过充分的抗结核治疗完整切除结核性脓肿可取得满意疗效。抗结核治疗联合或不联合开放引流都是可行的选择。