CAJ | 학술논문

目的：探讨 CT 引导下经皮病灶内置管局部化疗治疗脊柱结核的疗效。方法回顾分析2010年5月至2013年10月，27例行 CT 引导下椎间隙穿刺置管局部化疗的脊柱结核患者的临床及随访资料，其中男15例，女12例，年龄34～88岁，平均(56±14)岁。单纯椎间隙化疗19例，椎间隙化疗同时留置引流管持续脓肿冲洗8例。采用疼痛视觉评分( visual analogue scale，VAS )评价病患主诉症状缓解情况，术前及术后第1、2、3、4周监测患者血沉( erythrocyte sedimentation rate，ESR )及 C 反应蛋白( C-reactive protein，CRP )评价感染控制情况。结果全部手术均在 CT 引导下顺利完成，均未出现手术并发症。脓肿冲洗14～52天，平均(29±11)天，局部化疗28～75天，平均(44±12)天。随访时间12～30个月，平均(19±4)个月，随访期间症状体征均无复发，脓肿消失，VAS 评分由术前平均(6.5±0.9)分降至治疗后4周(2.4±0.7)分(P＜0.05)。患者术前 CRP 平均为(38.9±11.3) mmol / L，大多数患者的 CRP 在术后第1周出现反弹，但差异无统计学意义(P＞0.05)，在术后2周明显下降(22.2±7.1)(P＜0.05)，而第3周(13.4±3.2)、第4周(11.1±3.9)(P＜0.05)时已显著降低。结论 CT 引导下经皮病灶内置管局部化疗治疗脊柱结核疗效好，创伤小；同时对于全身情况差的高龄患者，也可达到缓解症状、改善生存质量的目的。
목적：탐토 CT 인도하경피병조내치관국부화료치료척주결핵적료효。방법회고분석2010년5월지2013년10월，27례행 CT 인도하추간극천자치관국부화료적척주결핵환자적림상급수방자료，기중남15례，녀12례，년령34～88세，평균(56±14)세。단순추간극화료19례，추간극화료동시류치인류관지속농종충세8례。채용동통시각평분( visual analogue scale，VAS )평개병환주소증상완해정황，술전급술후제1、2、3、4주감측환자혈침( erythrocyte sedimentation rate，ESR )급 C 반응단백( C-reactive protein，CRP )평개감염공제정황。결과전부수술균재 CT 인도하순리완성，균미출현수술병발증。농종충세14～52천，평균(29±11)천，국부화료28～75천，평균(44±12)천。수방시간12～30개월，평균(19±4)개월，수방기간증상체정균무복발，농종소실，VAS 평분유술전평균(6.5±0.9)분강지치료후4주(2.4±0.7)분(P＜0.05)。환자술전 CRP 평균위(38.9±11.3) mmol / L，대다수환자적 CRP 재술후제1주출현반탄，단차이무통계학의의(P＞0.05)，재술후2주명현하강(22.2±7.1)(P＜0.05)，이제3주(13.4±3.2)、제4주(11.1±3.9)(P＜0.05)시이현저강저。결론 CT 인도하경피병조내치관국부화료치료척주결핵료효호，창상소；동시대우전신정황차적고령환자，야가체도완해증상、개선생존질량적목적。
Objective To investigate the therapeutic effects of the treatment of spinal tuberculosis with CT-guided percutaneous intubation and focal chemotherapy.Method From May, 2010 to October, 2013, a total of 27 cases with spinal tuberculosis treated by CT-guided percutaneous intubation and focal chemotherapy were reviewed retrospectively. There were 15 males and 12 females aging from 34 to 88 years old with the average of ( 56±14 ) years old. Nineteen cases received simple persistent focal chemotherapy, while the other 8 cases received persistent irrigation and drainage at the same time. Visual analogue scale ( VAS ) was used to evaluate patients’ complaint of back pain. Erythrocyte sedimentation rate ( ESR ) and C-reactive protein ( CRP ) preoperatively and 1, 2, 3, 4 weeks postoperatively were used to observe infection.Results All surgeries were taken under the guidance of CT scan, and no complications were detected. Persistent irrigation and drainage of tuberculosis abscesses lasted 14 to 52 days ( average: 29±11 days ). Focal chemotherapy lasted 28 to 75 days ( average: 44±12 days ). All patients were followed up for 12 to 30 months ( average: 19±4 months ). No relapse was detected, and abscess disappeared. VAS scale reduced signiifcantly from 6.5±0.9 preoperatively to 2.4±0.7 four weeks postoperatively (P<0.05 ). CRP level before surgery was ( 38.9±11.3 ) mmol / L. In most patients CRP level had a rebound 1 week postoperatively, but was not statistically signiifcant (P>0.05 ). Figures decreased signiifcantly at 2 weeks ( 22.2±7.1 ) (P<0.05 ), and even lower at 3 weeks ( 13.4±3.2 ) and 4 weeks ( 11.1±3.9 ) (P<0.05 ).Conclusions Treatment of spinal tuberculosis with CT-guided percutaneous intubation and focal chemotherapy showed its advantages of good effects and less invasion. And for the aged patients with poor general condition, pain-release and life quality can be improved.