经皮内镜下病灶清除灌洗局部化疗治疗腰椎结核

发布时间：2018-03-04 01:16

本文选题：腰椎结核　切入点：经皮椎间孔镜　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨经皮内镜下结核病灶清除、置管持续灌洗引流、局部化疗治疗腰椎结核的安全性、可行性及临床疗效。方法选择15例腰椎结核患者，采用PESS（Percutaneous endoscopicspine surgery）在静脉麻醉下清除结核病灶，放置引流管持续灌洗引流，局部应用异烟肼（INH）注射液，时间12～18d。术前及术后1,3,6,12,18个月随访记录患者血沉结果（ESR）及Oswestry功能障碍指数(OswestryDisability Index，ODI)评分，术后1,3,12月行CT或MRI检查；所收集血沉数据及评分使用SPSS软件进行单因素t检验分析。结果15例患者手术顺利，术中患者耐受性好，病灶清除及置管放置顺利，，有1例术后8天引流管掉落，再次行置管手术，所有患者没有出现神经、血管、硬脊膜损伤等并发症。所有患者获得随访15～24个月，术后1、3、6、12、18个月分析血沉结果及ODI功能评分均比术前有显著下降（P0.05），患者在末次随访时均获得临床治愈。结论经皮内镜下病灶清除灌洗局部化疗有创伤小、出血少、费用低、术后恢复快、临床疗效良好等优点，是治疗无严重脊柱后凸畸形和严重的神经功能损伤的腰椎结核可供选择的方法。
[Abstract]:Objective to investigate the safety, feasibility and clinical effect of percutaneous endoscopic tuberculosis (TB) removal, continuous irrigation and drainage, and local chemotherapy in the treatment of lumbar tuberculosis. Methods Fifteen patients with lumbar spinal tuberculosis were treated with PESS(Percutaneous endoscopicspine surgery.These patients were treated with PESS(Percutaneous endoscopicspine surgery.These patients were treated with isoniazid (isoniazid) injection. The results of ESR and OswestryDisablity Index (Oswestry) were recorded before and after 18 months. Ct or MRI were performed on December. The data of ESR and SPSS were analyzed by single factor t test. Results the operation was successful in 15 patients, the patient was well tolerated during the operation, the focus was cleared and the tube was placed smoothly. The drainage tube dropped 8 days after operation in 1 case, and the tube was placed again. There were no nerves and blood vessels in all the patients. All the patients were followed up for 15 ~ 24 months, and the results of ESR and ODI scores were significantly decreased after 18 months compared with those before operation (P 0.05). All the patients were cured at the last follow-up. Conclusion Local chemotherapeutic therapy with percutaneous endoscopic debridement and lavage has the advantages of less trauma, less bleeding, low cost, quick postoperative recovery and good clinical effect. It is an alternative treatment for lumbar tuberculosis without severe kyphosis and severe neurological impairment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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