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目的探讨CT引导下经皮肺穿空洞内置管介入治疗重症空洞肺结核的可行性、临床疗效和治疗意义。方法32例重症空洞型肺结核住院患者随机分成2组,均用3VHPThZAk/15VPaTh化疗方案治疗,治疗组16例配合CT引导下经皮肺穿空洞内置管引流注入抗结核药的介入方法进行治疗并完成疗程。结果疗程结束后,临床观察治疗组痰菌阴转率75.0%(12/16),病灶显著吸收率62.5%(10/16),明显高于对照组的43.8%(7/16)和31.3%(5/16)(P均<0.05)。治疗3个月时治疗组痰菌阴转率56.3%(9/16),显著高于对照组的31.3%(5/16)(P<0.05)。空洞闭合率和空洞缩小率2组相比较差异无统计学意义(P>0.05),但较小的薄壁空洞和干酪空洞的闭合率较高。空洞内仍然存在液平的比率治疗组为9.1%远低于对照组的80%(P<0.01)。结论CT引导下经皮肺穿空洞内置管引流注入抗结核药是治疗重症空洞肺结核的一种新方法,与其他介入治疗方法相比较具有较好的治疗效果,并且有安全、微创、无明显不良反应等优点。由于病例数尚少,需进一步积累经验。
Objective To investigate the feasibility, clinical curative effect and therapeutic significance of interventional treatment of severe empty tuberculosis by CT-guided percutaneous pulmonary perforating tunnel insertion. Methods Thirty-two patients with severe tuberculosis admitted to hospital were randomly divided into two groups, each of which was treated with 3VHPThZAk / 15VPaTh chemotherapy. Sixteen patients in the treatment group were treated with CT-guided drainage of anti-TB drugs through percutaneous pulmonary perforated hollow tunnels and completed Course of treatment. Results After the treatment, the sputum negative conversion rate was 75.0% (12/16) in the clinical observation group, and the significant absorption rate was 62.5% (10/16) in the treatment group, which was significantly higher than 43.8% (7/16) and 31.3% in the control group (5/16) (P <0.05). At 3 months of treatment, sputum negative conversion rate was 56.3% (9/16) in the treatment group, which was significantly higher than that in the control group (31.3%, 5/16) (P <0.05). There was no significant difference between the two groups (P> 0.05). However, the closure rates of the smaller thin-walled hollows and the cheese cavities were higher. The level of fluid remaining in the cavity was 9.1% in the treatment group, which was significantly lower than 80% in the control group (P <0.01). Conclusion CT-guided insertion of anti-TB drugs into the drainage tube of perforation of perforation of the percutaneous lung is a new method for the treatment of severe pulmonary tuberculosis. Compared with other interventional methods, the anti-TB drugs have better therapeutic effect and are safe, less invasive and less obvious Adverse reactions and other advantages. Due to the small number of cases, we need to further accumulate experience.