中文摘要：

目的回顾性探讨外科干预治疗模式在窦道型结核性创面修复中的效果。方法2010年1月—2015年10月，笔者单位收治符合入选标准的43例窦道型结核性创面患者，根据不同的治疗方式和患者意愿，将患者分为试验组38例和对照组5例。试验组患者首先口服抗结核药物至少3周，采用磁共振成像结合三维重建软件精确评估创面；然后彻底切除窦道及其周围失活组织，并行VSD治疗（负压值为－26.6 kPa，持续吸引1～2周，每7天更换1次敷料）；再通过直接缝合或移植皮片、皮瓣覆盖创面。对照组患者首先口服抗结核药物至少3周，然后于门诊常规换药处理，每3天更换1次敷料。2组患者均于治疗结束后口服抗结核药物至少6个月，并随访6～36个月。统计2组患者的结核杆菌、抗酸杆菌及结核肉芽肿检出情况，创面愈合时间，复发情况；统计试验组患者的单条窦道率、2条窦道率、3条及以上窦道率。对数据行Fisher确切概率法检验和Wilcoxon秩和检验。结果试验组和对照组患者各有5例、2例创面检出结核杆菌，有8例、3例创面抗酸杆菌染色阳性，有27例、4例创面呈典型结核肉芽肿表现，组间比较差异均无统计学意义（P值分别为0.238 4、0.154 4、1.000 0）。试验组患者创面愈合时间中位数为19.6 d，明显短于对照组（94.4 d，χ2＝12.986 0，P＝0.000 3）。试验组、对照组分别有2、1例患者复发结核性创面，两组之间比较差异无统计学意义（P＝0.363 0）。试验组38例患者中，单条窦道率为23.7%（9/38）、2条窦道率为28.9%（11/38）、3条及以上窦道率为47.4%（18/38）。结论应用＂抗结核治疗＋精确创面评估＋清创术＋VSD治疗＋外科修复术＂的外科干预治疗模式修复窦道型结核性创面，有助于在明确窦道走行的前提下制订最佳手术方案，降低手术风险。

英文摘要：

Objective To retrospectively explore the effectiveness of surgical intervention model for repairing the tuberculosis wound with sinus tract. Methods Forty-three patients with tuberculosis wound with sinus tract who met the inclusion criteria were admitted to the 309th Hospital of PLA from January 2010 to October 2015. These patients were divided into test group （ n =38） and control group （ n =5） accord- ing to the different treatment and patient＇s consent. Patients in test group were treated as follows. Firstly, antituberculosis drugs were taken orally for at least 3 weeks, and the wounds were accurately assessed using magnetic resonance imaging combined with 3-dimensional reconstruction software. Then sinus tract and its surrounding devitalized tissue were completely excised, and vacuum sealing drainage （VSD） treatment with negative pressure value of - 26.6 kPa was performed for 1 to 2 weeks （ dressing change was performed per 7 days）. Lastly, the wounds were covered through direct suture or grafting skin or flap. Patients in control group were firstly given antitubercuIosis drugs orally for at least 3 weeks, and then they were treated with routine dressing change in outpatient service every 3 days. After the former therapy, patients in both groups were given antituberculosis drugs by oral administration for at least 6 months and were followed up for 6 to 36 months. Detection of Bacillus tuberculosis , Acid-fast bacilli , and tuberculosis granuloma, wound healing time, and relapse of tuberculosis wound in patients of both groups were recorded. The rates of single sinus tract, two sinus tracts, and more than or equal to 3 sinus tracts of patients in test group were recorded. Data were processed with Fisher＇s exact test and Wilcoxon rank-sum test. Results Bacillus tuberculosis was respectively detected in wounds of 5 patients in test group and 2 patients in control group. Acid-fast bacilli were positively expressed in wounds of 8 patients in test group and 3 patients in control group. A typical