Hsu H S, Wang L S, Wu Y C, Fahn H J, Huang M H
Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, ROC.
Scand J Thorac Cardiovasc Surg. 1995;29(3):119-23. doi: 10.3109/14017439509107217.
Primary tuberculosis of the chest wall is rare and its clinical presentation may resemble pyogenic abscess or tumour. The diagnosis is difficult, since smears or cultures of aspirate frequently fail to show tubercle bacilli. Seven cases of primary chest-wall tuberculosis treated between 1973 and 1992 are described. All presented with a progressively enlarging mass. The diagnosis was based on bacteriologic and histologic findings, but definitive diagnosis was obtained before treatment in only two cases. Satisfactory results were obtained with surgical debridement and specific chemotherapy in six cases and with chemotherapy alone in one case. From this limited experience, we suggest that primary chest-wall tuberculosis should initially be treated with a combination regimen of antituberculous chemotherapy, which should take more than 9 months. If the lesion progressively enlarges or secondary infection occurs, however, adequate surgical debridement is also required.
胸壁原发性结核较为罕见，其临床表现可能类似化脓性脓肿或肿瘤。诊断困难，因为抽吸物涂片或培养往往无法显示结核杆菌。本文描述了1973年至1992年间治疗的7例胸壁原发性结核病例。所有患者均表现为肿块逐渐增大。诊断基于细菌学和组织学检查结果，但仅2例在治疗前获得明确诊断。6例患者通过手术清创和特异性化疗取得了满意效果，1例仅接受化疗。基于这一有限经验，我们建议胸壁原发性结核最初应采用抗结核化疗联合方案治疗，疗程应超过9个月。然而，如果病灶逐渐增大或发生继发感染，则还需要进行充分的手术清创。
