| 1、Background and ObjectiveSince the end of last century, because of the tuberculosis control work’s ignoring,the population flow increased gradually, more and more drug-resistant TB, TB and HIV co-infection, dealing to the tuberculosis(TB) recovery in the global scope.Do harm to human health seriously, and not only a serious public health problem, but also has become an important problem affecting the social and economic development. In 1993 the world health organization(WHO) declared "tuberculosis emergency" in the world, our country is one of 22 high TB burden countries in the world, the number of TB patients ranking second in the world(the first) in India. How’s the progress of tuberculosis control work in China will directly affect the global TB control strategy implementation and results, received extensive attention of the international community.Although the incidence of TB in developed countries has been significantly reduced, but it is still a common condition in many developing countries. Accordingly, in the surgical treatment of tuberculosis, tuberculosis treatment strategy of developed countries and developing countries are obviously different. In developing countries, surgery is still the important treatment to cure tuberculosis, 2-5% tuberculosis need surgical treatment to cure. With the increase of global drug-resistant TB, the importance of surgical intervention is more and more significant. The history of 100 years of history of surgical treatment of tuberculosis. Before the time of chemotherapy for tuberculosis and tuberculosis in the surgical treatment is given priority to with atelectatic surgery, such as artificial pneumothorax, artificial pneumoperitoneum, thoracic retrofit technique, etc. Relative to the tuberculosis, extrapulmonary tuberculosis(TB) in diagnosis and treatment of surgical intervention has important meaning. Era before chemotherapy, joint tuberculosis can only make drainage, but as a result of postoperative mortality is higher, cut out the white pus, so called "white plague" at that time, there are "opened the door to open lesions is equal to death," said..Four, the fifties of the last century, domestic Fang Xian zhi professor for removal of bone tuberculosis deep lesions to be successful, make bone tuberculosis postoperative mortality is significantly reduced. Wu Yingkai academician reported in 1959, the new decade tuberculosis surgical treatment of postoperative complications was 17%, in 1994, domestic Zhao Xingji reported tuberculosis incidence of postoperative complications by 9%, in 2012, a report meta analysis of surgical treatment of multi-drug resistant tuberculosis, tuberculosis incidence of postoperative complications in 15%, is the main complication of bronchial BPF, etc. And bone tuberculosis, lymphatic tuberculosis and chest wall tuberculosis, postoperative incision healing not more common.Long, postoperative incision healing tuberculosis and fistula formation, mainly since the preoperative chemotherapy, no treatment, lesion clearance incomplete, improper operation mode, operation time was not right, such as the literature at home and abroad have reported that, in particular, see more at extra pulmonary tuberculosis after surgery, such as lymphoid tuberculosis, chest wall tuberculosis, bone tuberculosis, joint tuberculosis, pyothorax, etc. Because of tuberculosis(TB) postoperative incision to heal, the incidence of complications, directly affects the clinical diagnosis and treatment of tuberculosis. Although the mechanism of this phenomenon is not good, but many treatment methods, such as traditional Chinese medicine, repeated operation, adjustment of anti-tb drugs and so on, but the treatment effect is not obvious. Not found in the literature, from the Angle of bacteriology, molecular biology, pathogens and postoperative incision don’t heal relations research for a long time. Can say the past 60 years, TB did not significantly reduce postoperative complications. It is a long-term problem of doctors and patients worldwide, so that in the standard chemotherapy for tuberculosis and tuberculosis DOTS, DOTS and other chemical treatment success, surgical mortality significantly lower today, this problem is still common, of a smell, but they feel used. The recent design, this study first by drainage and tuberculosis lesions removal surgery drainage physical characteristics, number of mycobacterium tuberculosis detection, cytokines and so on, has proven its relationship with delayed healing of incision. Preliminary proven postoperative drainage physical properties, the number of mycobacterium tuberculosis, cytokines and other relations with delayed healing of incision, and for TB operation method choice, intra operative medicine way, provides the basis for sustained release study late, its clinical significance.2、SolutionPatients into a set of conditions: the experimental group are extra pulmonary tuberculosis, such as lymphoid tuberculosis, chest wall tuberculosis, pyothorax, joint tuberculosis, such as preoperative anti-tuberculosis treatment for more than 2 weeks at least, there is no other disease complications, no multi-drug resistant TB and non mycobacterium tuberculosis patients. The control for a class of incision patients, all for segment resection of the thyroid and mammary gland, no HIV and other immune diseases.Clinical group: randomly divided into 2 groups, 60 cases, tuberculosis of TB patients 60 cases. Each group of 3 to 7 times a sampler.Operation method: lesions removal surgery, routine use of hydrogen peroxide solution, iodine volts and physiological saline flushing residual cavity, and then randomly placed rifampicin 1 only. Placed drainage tube for a drainage fluid.Charge sample set detection: respectively for 6 h, 12 h, 24 h, 3 d, 5 d, 7 d, 9 d drainage fluid.Detection: application of fluorescence quantitative rt-pcr method to detect mycobacterium tuberculosis in different periods of drainage liquid quantity(smear and culture, nucleic acid, etc.); Collected specimens of different time periods in determination of cytokines, respectively analyzes the data, observation of TB lesions removal surgery number of mycobacterium tuberculosis(smear and culture, nucleic acid, etc.) and cell factor effect on healing of incision. The experimental data with SPSS 17. 0 statistical software analysis, in order to P < 0. 05 said the difference was statistically significant.3、Results60 cases of tuberculosis person at different times from the drainage of liquid in the specimens of 300 cases of 175 specimens were detected. Of the fluorescence quantitative rt-pcr method measured concentrations of n/med tuberculosis bacili longer duration of postoperative patients, and the incision healing time is shorter; N/med tuberculosis bacili concentration does not change significantly with the extension of time after or patients with elevated, incision healing for a long time, the local residual concentrations of mycobacterium tuberculosis and tuberculosis(TB) postoperative incision incision healing time were positively correlated. Cytokines tuberculosis detection method in the specimens and the specimens of non-tuberculosis IL- 6, the level of VEGF- A high, PDGF- BB(77)(48), TNF, IFN- A- A(45) concentrations were significantly non-tuberculosis in tuberculosis specimens of low concentration in the sample.4、ConclusionThis experiment combined with the literature, experimental System and individual operating errors, due to the application of 7500 Real- time PCR System, the detection sensitivity is limited, many specimens after fluorescence quantitative PCR, effective concentration was not detected. The local residual concentrations of mycobacterium tuberculosis and tuberculosis(TB) postoperative incision incision healing time were positively correlated, TB need long-term use of effective anti-tb drugs to reduce postoperative incision local residual concentrations of n/med tuberculosis bacterium to reduce patient incision healing time. Cytokines tuberculosis detection method in the specimens and the specimens of non-tuberculosis IL-6, the level of VEGF- A high, PDGF- BB(77)(48), TNF, IFN- a- a(45) concentrations were significantly non-tuberculosis in tuberculosis specimens of low concentration in the sample. Bold speculation PDGF- BB(77)(48), TNF, IFN- a- a(45) in postoperative incision delayed healing tuberculosis has inevitable relations. For later research in tuberculosis of cytokine therapy on postoperative incision delayed healing laid a solid foundation. |
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