Zhang Ting, Yang Bin, Xu Xiaohong, Zhang Zengfang, Pan Zhenglun
Department of Rheumatology, Shandong University Qilu Hospital, China.
Qingdao Key Laboratory of Mitochondrial Medicine, China.
PLoS One. 2025 Jan 24;20(1):e0313586. doi: 10.1371/journal.pone.0313586. eCollection 2025.
The efficacy, safety, optimal timing, and urate-lowering effects of surgical interventions in gout management remain poorly understood. This study aims to fill this gap by evaluating the role of surgery in treating gout patients with tophi.
A retrospective analysis was conducted on 28 gout patients presenting with tophi. Data were comprehensively retrieved from electronic medical records, including medical history, laboratory findings, surgical procedures, hospitalization duration, postoperative monitoring, and relevant variables.
Postoperative improvements were observed in joint symptoms and functionality. Surgical intervention effectively reduced the frequency of gout flares, demonstrating short-term urate-lowering effects (STULE) and potential long-term urate-lowering effects (LTULE) when combined with urate-lowering treatments (ULT). Primary healing occurred in 65 out of 67 surgical sites (97.01%), with only 2 sites (2.99%) experiencing delayed healing, and minimal complications reported. Prolonged hospital stays were associated with elevated leukocyte counts, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels, as well as a higher number of surgical sites, rather than serum uric acid (SUA) levels.
Surgical intervention is a promising and safe therapeutic option for managing gout, particularly in cases with joint deterioration, functional impairment, or nerve involvement. Surgery not only reduces the frequency of gout flares but also provides STULE and potential LTULE when complemented with ULT. Patients with lower inflammatory indices and fewer incisions exhibit faster postoperative recoveries. Optimal timing of surgery, ideally during periods of disease remission, is crucial for minimizing complications and reducing hospitalization durations.
手术干预在痛风治疗中的疗效、安全性、最佳时机及降尿酸效果仍未得到充分了解。本研究旨在通过评估手术在治疗痛风石痛风患者中的作用来填补这一空白。
对28例有痛风石的痛风患者进行回顾性分析。从电子病历中全面检索数据，包括病史、实验室检查结果、手术操作、住院时间、术后监测及相关变量。
术后关节症状和功能得到改善。手术干预有效降低了痛风发作频率，与降尿酸治疗（ULT）联合使用时显示出短期降尿酸效果（STULE）和潜在的长期降尿酸效果（LTULE）。67个手术部位中有65个（97.01%）实现一期愈合，仅有2个部位（2.99%）愈合延迟，且报告的并发症极少。住院时间延长与白细胞计数、C反应蛋白（CRP）和红细胞沉降率（ESR）水平升高以及手术部位数量较多有关，而非血清尿酸（SUA）水平。
手术干预是治疗痛风的一种有前景且安全的治疗选择，尤其适用于关节恶化、功能受损或神经受累的病例。手术不仅降低了痛风发作频率，而且在与ULT联合使用时还能提供STULE和潜在的LTULE。炎症指标较低且切口较少的患者术后恢复更快。理想的手术时机是在疾病缓解期，这对于减少并发症和缩短住院时间至关重要。
