2.结核性脓胸:手术方式有改进的胸腔引流术、胸膜纤维板剥脱术、胸廓成形术、胸膜肺切除术、带蒂大网膜移植术、肌瓣填塞术等[95]。胸腔镜在脓胸治疗中的应用,有报道为28.6%,而在发展中国家,还是以常规手术为主。Thomas等[96]报道脓胸93例,胸膜剥脱术49例(52.7%)、肺叶切除术29例(31.2%)、全肺切除术15例(16.1%)。其中3例手术死亡,分别是肺叶切除2例,胸膜剥脱术1例。作者指出,对体质弱、肺功能差的脓胸患者,特别是合并毁损肺的老年患者,胸腔的闭式引流仍是可供选择的手术措施。
3.胸壁结核:手术治疗原则为彻底清除病灶,消灭残腔,术后残腔的处理对预后有直接影响。徐澄澄等[97]报道采用带蒂大网膜移植治疗9例难治性胸壁结核,所有患者都一次性手术治愈,随访9个月至2年无一例复发。詹锋等[98]通过残腔内置入负压引流海绵治疗32例胸壁结核,所有患者均顺利治愈,随访l~2年无复发。
4.微创外科:近年来,胸腔镜已经在结核外科有了比较广泛的应用[99],可用来行常规的肺切除术、胸膜结核球切除术、结核性脓胸和脊柱结核病灶清除术,胸腔镜手术技巧熟练的医师甚至可完成肺结核毁损肺等复杂手术的操作,而达到创伤小、出血少的效果。最近,我国多家医院成功开展了后腹腔镜结核性无功能肾切除术,同样取得良好疗效。姜永光等[100]经阴道辅助腹腔镜肾切除术治疗结核无功能肾1例也取得了成功。
参加编写人员:200433同济大学附属上海市肺科医院(唐神结、胡忠义、张青、范琳、崔振玲、刘一典);首都医科大学附属北京胸科医院(张宗德、谢汝明、白连启、陆宇、杜凤娇);山东省胸科医院(张延安、侯代伦、金锋);解放军第三〇九医院(张广宇、陈志);广州市胸科医院(胡族琼);长春市传染病医院(闫世明、赵云虹);沈阳市胸科医院(邢勇、孙炳奇)志谢 安徽省铜陵市第二人民医院朱友生教授及上海市肺科医院方园园、吕艳医生进行了大量的文字校对与修订工作
参 考 文 献
[1]Mukherjee T,Boshoff H.Nitroimidazoles for the treatment ofTB:past,present and future.Future Med Chem,2011,3(11):1427-1454.
[2]Ahmad Z,Peloquin CA,Singh RP,et al.PA-824exhibitstime-dependent activity in a murine model of tuberculosis.Antimicrob Agents Chemother,2011,55(1):239-245.[3]Diacon AH,Dawson R,Hanekom M,et al.Early bactericidalactivity of delamanid(OPC-67683)in smear-positive pulmo-nary tuberculosis patients.Int J Tuberc Lung Dis,2011,15(7):949-954.
[4]Thompson AM,Sutherland HS,Palmer BD,et al.Synthesisand structure-activity relationships of varied ether linker ana-logues of the antitubercular drug(6S)-2-nitro-6-{[4-(trifluoro-methoxy)benzyl]oxy}-6,7-dihydro-5h-imidazo[2,1-b][1,3]oxazine(PA-824).J Med Chem,2011,54(19):6563-6585.[5]Tasneen R,Li SY,Peloquin CA,et al.Sterilizing activity ofnovel TMC207-and PA-824-containing regimens in a murinemodel of tuberculosis.Antimicrob Agents Chemother,2011,55(12):5485-5492.
[6]Leach KL,Brickner SJ,Noe MC,et al.Linezolid,the firstoxazolidinone antibacterial agent.Ann N Y Acad Sci,2011,(1222):49-54.
[7]黄海荣,于霞,姜广路,等.利奈唑胺对分枝杆菌体外抑菌作用的初步研究.中华结核和呼吸杂志,2011,(8):575-578.[8]Tang SJ,Zhang Q,Zheng LH,et al.Efficacy and safety of li-nezolid in the treatment of extensively drug-resistant tubercu-losis.Jpn J Infect Dis,2011,64(6):509-512.
[9]Singla R,Caminero JA,Jaiswal A,et al.Linezolid:an effec-tive,safe and cheap drug for patients failing multidrug-resistanttuberculosistreatment in India.Eur Respir J,2012,39(4):956-962.
[10]Alffenaar JW,van der Laan T,Simons S,et al.Susceptibilityof clinical Mycobacterium tuberculosis isolates to a potentiallyless toxic derivate of Linezolid,PNU-100480.AntimicrobAgents Chemother,2011,55(3):1287-1289.
[11]Wallis RS,Jakubiec W,Kumar V,et al.Biomarker-assisteddose selection for safety and efficacy in early development ofPNU-100480for tuberculosis.Antimicrob Agents Chemother,2011,55(2):567-574.
[12]Takiff H,Guerrero E.Current prospects for the fluoroquino-lones as first-line tuberculosis therapy.Antimicrob AgentsChemother,2011,55(12):5421-5429.
[13]Fouad M,Gallagher JC.Moxifloxacin as an alternative or ad-ditive therapy for treatment of pulmonary tuberculosis.AnnPharmacother,2011,45(11):1439-1444.
[14]桂徐蔚,肖和平,胡忠义,等.氯法齐明对不同耐药类型结核分枝杆菌的体外抑菌活性研究.中华结核和呼吸杂志,2011,34(8):579-581.
[15]Lu Y,Zheng M,Wang B,et al.Clofazimine analogs with effi-cacy against experimental tuberculosis and reduced potentialfor accumulation.Antimicrob Agents Chemother,2011,55(11):5185-5193.
[16]Singh V,Mani I,Chaudhary DK,et al.Theβ-ketoacyl-ACPsynthase from Mycobacterium tuberculosis as potential drug tar-gets.Curr Med Chem,2011,18(9):1318-1324.
[17]Saidemberg DM,Passarelli AW,Rodrigues AV,et al.Shiki-mate kinase(EC 2.7.1.71)from Mycobacterium tuberculosis:kinetics and structural dynamics of a potential molecular targetfor drug development.Curr Med Chem,2011,18(9):1299-1310.
[18]Shi W,Zhang X,Jiang X,et al.Pyrazinamide inhibits trans-translation in Mycobacterium tuberculosis.Science,2011,333(6049):1630-1632.
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[19]Yang XY,Chen QF,Li YP,et al.Mycobacterium vaccae as ad-juvant therapy to anti-tuberculosis chemotherapy in never-trea-ted tuberculosis patients:a meta-analysis.PLoS One,2011,6(9):e23826.
[20]Dlugovitzky D,Stanford C,Stanford J.Immunological basisfor the introduction of immunotherapy with Mycobacteriumvaccae into the routine treatment of TB.Immunotherapy,2011,3(4):557-568.
[21]Gao XF,Yang ZW,Li J.Adjunctive therapy with interferon-gamma for the treatment of pulmonary tuberculosis:a syste-matic review.Int J Infect Dis,2011,15(9):e594-600.
[22]Scriba TJ,Tameris M,Mansoor N,et al.Dose-finding studyof the novel tuberculosis vaccine,MVA85A,in healthy BCG-vaccinated infants.J Infect Dis,2011,203(12):1832-1843.[23]Butov DA,Pashkov YN,Stepanenko AL,et al.Phase IIbrandomized trial of adjunct immunotherapy in patients withfirst-diagnosed tuberculosis,relapsed and multi-drug-resistant(MDR)TB.J Immune Based Ther Vaccines,2011,9:3.
[24]Arjanova OV,Prihoda ND,Yurchenko LV,et al.Adjunct o-ral immunotherapy in patients with re-treated,multidrug-re-sistant or HIV-coinfected TB.Immunotherapy,2011,3(2):181-191.
[25]Sheikh JA,Khuller GK,Verma I.Immunotherapeutic role ofAg85Bas an adjunct to antituberculous chemotherapy.J Im-mune Based Ther Vaccines,2011,9:4.

