CAJ | 학술논문

目的探讨耐多药脊柱结核的产生原因及临床处理对策.方法回顾性分析2007年6月至2012年9月收治的16例耐多药脊柱结核患者的相关资料,男12例,女4例；年龄10～49岁,平均26.6岁；累及椎体44个,平均2.75个.胸椎9例,腰椎2例,胸腰段1例,腰骶椎3例,1例累及跳跃节段(T8.9,T12L1).合并肺结核5例,结核性胸膜炎4例,结核性脓胸3例,颈部淋巴结核1例,胸骨结核1例,胸壁结核1例；肾病综合征1例.根据药敏试验制订个体化抗结核治疗方案,分析手术次数与过程,经过长期随访判断治疗效果,并分析耐多药产生原因.结果 16例患者中接受1次外科手术者6例；2次外科手术者7例；3次手术者2例,其中1例第3次手术为一期后路内固定、前路再次病灶清除植骨术；4次外科手术者1例,第4次为窦道切除术.随访时间10～60个月,平均28.4个月.通过术后药敏试验结果及时调整化疗方案,末次抗结核治疗时间为24个月.2例患者分别在术后22个月和46个月复发并再次手术.截止末次随访,所有患者均处于结核稳定状态.16例患者中2例为初始耐药,14例为获得性耐药,原因为反复多器官结核致数次抗结核治疗失败；经历多次失败手术未调整化疗方案；出现严重药物不良反应而被迫中断化疗等.结论早期进行结核菌培养并获取药敏试验结果,制定个体化的化疗方案并严密监测药物不良反应,选择合适的时机进行外科手术是防止和治愈耐多药脊柱结核的关键.
목적 탐토내다약척주결핵적산생원인급림상처리대책.방법 회고성분석2007년6월지2012년9월수치적16례내다약척주결핵환자적상관자료,남12례,녀4례；년령10～49세,평균26.6세；루급추체44개,평균2.75개.흉추9례,요추2례,흉요단1례,요저추3례,1례루급도약절단(T8.9,T12L1).합병폐결핵5례,결핵성흉막염4례,결핵성농흉3례,경부림파결핵1례,흉골결핵1례,흉벽결핵1례；신병종합정1례.근거약민시험제정개체화항결핵치료방안,분석수술차수여과정,경과장기수방판단치료효과,병분석내다약산생원인.결과 16례환자중접수1차외과수술자6례；2차외과수술자7례；3차수술자2례,기중1례제3차수술위일기후로내고정、전로재차병조청제식골술；4차외과수술자1례,제4차위두도절제술.수방시간10～60개월,평균28.4개월.통과술후약민시험결과급시조정화료방안,말차항결핵치료시간위24개월.2례환자분별재술후22개월화46개월복발병재차수술.절지말차수방,소유환자균처우결핵은정상태.16례환자중2례위초시내약,14례위획득성내약,원인위반복다기관결핵치수차항결핵치료실패；경력다차실패수술미조정화료방안；출현엄중약물불량반응이피박중단화료등.결론 조기진행결핵균배양병획취약민시험결과,제정개체화적화료방안병엄밀감측약물불량반응,선택합괄적시궤진행외과수술시방지화치유내다약척주결핵적관건.
Objective To investigate the causes and treatment strategies of spinal multidrug-resistance tuberculosis.Methods Data of 16 patients with spinal multidrug-resistance tuberculosis from Jane 2007 to September 2012 were retrospectively analyzed.There were 12 males and 4 females,with an average age of 26.6 years (range,10-49 years).The 16 patients involved 44 vertebrae,with an average of 2.75 vertebrae.The involved segments included:9 thoracic segments,1 thoracic-lumbar segment,2 lumbar segments and 3 lumbar-sacral segments.1 patient involved jumping segments including T8.9,T12L1.Among them,5 suffered from pulmonary tuberculosis,4 tuberculous pleurisy,3 tuberculous empyema,1 tuberculosis of cervical lymph nodes,1 tuberculosis of sternum,1 tuberculosis of chest wall and 1 nephrotic syndrome.We analyzed the reasons of multidrug-resistance.All patients received individualized chemotherapy based on drug sensitivity test.The operation process and time were also collected.The treatment effects were determined by long-term follow-up.Results Among all the 16 patients,6 received 1 operation; 7 received 2 operations; 2 received 3 operations and the last operation was one-stage posterior instrumentation and anterior debridement,bone grafting which conducted in our hospital; 1 received 4 operations and the last of which was excision of sinus in our hospital.All patients were followed up for 10 to 60 months (average,28.4 months).The time of chemotherapy which accorded to the drug sensitivity test was 24 months.2 cases recurred after 22 months and 46 months of the 1st surgery and received operation again.At the last follow-up,all patients were in a stable state of tuberculosis.In 16 patients,2 were initial drug resistance and 14 were acquired drug resistance.The causes of acquired drug resistance were multiple organs tuberculosis caused by failure chemotherapy,times of failed surgeries without adjusted schedules,suspension of the anti-tuberculosis chemotherapy due to serious adverse drug reactions and so on.Conclusion It is very important to carry through the culture of tubercle bacillus and acquire the results of drug sensitive test earlier.The key to prevent and cure multidrug-resistant tuberculosis of spine are formulating individualized anti-tuberculosis chemotherapy program,monitoring closely the adverse drug reactions and selecting the appropriate time for surgery.