ABSTRACT
Objective: To compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach. Methods: Between June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification ( P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification. Results: Except that the operation time of group B was significantly longer than that of group A ( t=-2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups ( P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups ( P0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up ( Z=-2.716, P=0.007). Conclusion: Posterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.
ABSTRACT
Objective To explore the application value of minimally invasive surgery in the treatment of lumbar spinal tuberculosis, and to provide reference for clinical treatment of spinal tuberculosis. Methods Data of 252 cases of patients with lumbar spinal tuberculosis treated by conservative treatment in our hospital from January 2005 to December 2014 were retrospectively analyzed. Patients were divided into four groups on the basis of systemic application of antituberculosis chemotherapy. A total of 154 patients were given simple local chemotherapy of percutaneous placement of focus catheter (group A), 48 patients were received percutaneous perfusion drainage and local chemotherapy (group B), 32 patients underwent percutaneous puncture catheter debridement combined with local chemotherapy (group C), and 18 patients were given percutaneous debridement and internal fixation combined with local chemotherapy catheter (group D). Data of erythrocyte sedimentation rate (ESR), visual analogue scale (VAS), Oswestry disability index (ODI) score and the modified MacNab criteria were recorded before operation and at the end of the follow-up in four groups of patients. Results Of the 252 patients, 228 were followed up and 214 patients achieved clinical cure. The lost access were15 cases in group A, 5 cases in group B, 2 cases in group C and 2 cases in group D. The total rate of lost visit was 9.52%. The follow up duration ranged from 25-126 months. The mean duration of follow-up was 68(60, 76) months. A total 214 cases reached the standard of clinical cure. No complications (retrograde infection and cross infection) were found in all patients during treatment. ESR was statistically decreased to (7.26 ± 3.43) mm/1 h at the last follow-up (t=35.06, P=0.023) compared with that (44.96 ± 12.42) mm/1 h before operation. The VAS and ODI were 1.5(1, 3) and 30(25, 35)% at the last follow-up, which were significantly improved than those [7.5(7.0, 8.0) and 60(55, 65)%] before operation (Z=13.641 and 6.806, P<0.05). According to the improved MacNab criteria, the overall excellent and good rates for patients were 86.4%(197/228) at the last follow-up. Conclusion According to the stepped care and personalized treatment, patients of lumbar tuberculosis are preoperative comprehensive evaluated, and most patients can achieve long-term stability and a better clinical efficacy after interventional and minimally invasive treatment.
ABSTRACT
Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy for loco-regionally recurrent or mastastatie rectal cancer. Methods Between June 2004 and January 2007,47 patients with loco-regionally recurrent or nmatastatic rectal cancer were treated by 3DCRT of 55-65 Gy in 1.8-2.0 Gy fractions. Chemotherapy was given concurrenfly using oxaliplatin(100 mg/m2 ,iv drop,d1 ) and capecitabine(1500 mg/m2,orally,dl-14,21 days per cycle). Results After the follow-up of 12-35 months, the total response rate, complete response rate and partial response rate were 79% (37/47) ,19% (9/47) and 60% (28/47) ,respectively. The pain-alleviation rate and the mean pain-alleviation time were 85% and 6 months. The 1- and 2-year survival rates were 83% and 51%. Quality of life was improved without any treatment related death. Conclusions 3DCRT combined with concurrent chemotherapy is effective and well-tolerated in patients with post-operatively locoregionally recurrent or mastastatic rectal cancer.
ABSTRACT
AIM: To study the influence on the expression of proliferation cell nuclear antigen(PCNA) in rectal carcinoma through retention -enema with FUDR and 5 -FU. METHODS: 80 cases of rectal carcinomas were randomized into three groups: the FUDR group(30 cases), the 5-FU group(30 cases) and normal control group(20 cases), treated with FUDR(500mg), 5-FU(500mg) and normal saline(20ml ) everynight through retention - enema separately for serven days- Mucosa of rectal car cinoma were sampled and PCNA protein were simultaneously detected by imrnunohistochemical method on the first and eighth day. RESULTS: The expression of PCNA was significantly decreased in both FUDR group and 5 - FU group after treatment(P 0. 1). CONCLUSION:The cell proliferation of rectal carcinoma could be inhibited by FUDR and 5-FU through retention-enema. The effects of FUDR was more obvious than that of 5-FU in the same concentration. so the treating method through retention-enema with FUDR should be used as a routine therapeutic scheme befOre operation.