肠结核诊断及其外科手术方法探讨（附23例肠结核外科诊治分析）

目的 探讨目前肠结核的诊断和外科治疗方法。 方法 回顾分析2008年1月至2010年12月吉林大学第一医院外科治疗23例肠结核患者的临床治疗情况。 结果23例患者中,术前通过肠镜病理诊断肠结核4例;结合病史、影像学检查、实验室检查疑诊肠结核12例,其余7例因怀疑腹腔肿瘤或需急诊手术未能术前确诊。所有患者均经术后病理确诊为肠结核,术后接受抗结核药物治疗,停药后随访1年,除3例失访外,治愈13例,好转7例,其中3例出现粘连性不全肠梗阻症状（3/7）,2例排便习惯改变 (2/7),2例有间断腹部隐痛(2/7)。 结论 早期诊断、正规的抗结核药物治疗及正确地选择手术适应证、术式,可以提高肠结核的治疗效果,是成功治疗肠结核的关键。     

肺结核咯血的外科治疗及疗效观察

目的 探讨肺结核合并咯血的外科治疗的适应证及手术方法.方法 回顾分析2008年10月至2012年10月在我院治疗的42例肺结核合并咯血患者的临床资料.结果 本组42例患者,行全肺切除1例,肺叶切除30例,肺楔形切除11例.术后仍有少量咯血5例,术后胸腔内出血而再次行手术治疗1例,术后肺不张、胸腔积液4例,切口感染2例,支气管胸膜瘘2例;并发症发生率为21.4％ (9/42),治愈率88.1％ (37/42).结论 外科手术是治疗肺结核大咯血和长期反复少量或中量咯血的综合治疗措施中较为有效的方法,手术原则以择期手术下肺叶切除方式为主.     

T-SPOT.TB在结核病诊断中的应用价值

结核病在全球仍然是重大的公共健康问题.目前传统诊断方法均难以令人满意.以早期分泌抗原靶6及培养滤过蛋白-10为刺激抗原的T SPOT.TB诊断试验,证实在活动性肺结核、潜伏性肺结核的诊断均优于传统诊断方法,且在结核病预后研究中也有较大的潜力.随着对其进一步的研究,其将在新世纪的结核病诊疗过程中发挥更重要的作用.     

支气管结核介入诊治的认识和思考

支气管结核（EBTB）的介入诊断和治疗有了长足的进展,但也面临着诸多的问题,有必要加深认识和思考。EBTB的支气管镜下目前分为5型,即炎症浸润型（Ⅰ型）、溃疡坏死型（Ⅱ型）、肉芽增殖型（Ⅲ型）、瘢痕狭窄型（Ⅳ型）和管壁软化型（Ⅴ型）,建议在原来EBTB＂五型＂的基础上将结核性支气管瘘从第Ⅱ型中分离出来成为单独的类型,即Ⅵ型。在支气管结核的治疗中,应根据不同的类型,采用包括高频电刀、冷冻、氩气刀、激光、支架置入、球囊扩张以及黏膜下穿刺注射抗结核药物等综合介入技术进行治疗。     

Role of surgical treatments in patients with fibrocavernous pulmonary tuberculosis

Three hundred and seventy patients operated on at the Institute Surgical Clinic underwent 638 surgical interventions: 356 and 282 in Groups 1 and 2 patients, respectively. Intraoperative complications occurred in 24 (3.8%) cases, in 6.5% of the patients operated on. Twenty-two complications were successfully eliminated, 2 patients died. Postoperative complications were established in 25 (14.8%) of the 169 patients of Group 1 and in 12 (6.0%) of the 201 patients of Group 2. The incidence of complications largely depended on the type of an operation. Complications were observed in 8 (36.4%) of the 22 patients undergone pulmonectomy. The active phase of a specific process as a surgical risk factor is prime consideration. In patients operated for emergency indications in the phase of an non-arrested exacerbation of tuberculosis, pleuropulmonary complications occur 2.5 times as frequently as those in patients with relative process stabilization.     

Ex juvantibus therapy in the differential diagnosis of urogenital tuberculosis

To make a differential diagnosis, 274 patients were followed up. Of them 68 patients were further found to have urinary tuberculosis that was verified by hypodermic tuberculin test, 15 patients underwent tuberculin diagnosis without special preparation, and 20 required type 1 ex juvantibus therapy. Challenge treatment with low-spectrum antituberculous agents in usual doses for 2 months confirmed the diagnosis in 3 patients and excluded it in other 3.     

Role of GeneXpertMTB/RIF in the diagnosis of cutaneous tuberculosis

Backgroundcutaneous involevemtn is an important extrapulmonary manifestation of tuberculosis. It is a paucibacillary condition and has diverse clinical presentations. Sufficient data is not available regarding role of GeneXpertMTB/RIF in cutanoues tuberculosis.Methodsin this study, BacT/Alert3D and response to antitubercular therapy were taken as gold standard and performance of GeneXpertMTB/RIF was evaluated against it in clinically and histopathologically suspected cases of cutaneous tuberculosis.Resultsforty seven patients were included in the study of which commonest presentation was scrofuloderma (42.6%) followed by lupus vulgaris (40.4%). Granulomatous inflammation on histopathology was seen in 75.5% patients on skin biopsy. Sic patients had extracutaneous focus of tuberculosis. In 14 (29.79%), culture of skin biopsy was positive for M. tuberculosis and all showed complete response to ATT in 6 months. GeneXpertMTB/RIF detected M. tuberculsois in 4 samples.ConclusionGeneXpertMTB/RIF is not a reliable tool for diagnosis of cutaneous tuberculosis. Clinic-histopathological correlation along with response to ATT is needed for confirmation of diagnosis of cutaneous tuberculosis.     

Role of computerized tomography in the diagnosis of cirrhotic pulmonary tuberculosis

Computed tomography (CT) revealed cirrhotic tuberculosis in 52 patients. In most patients, cirrhosis resulted from infiltrative and fibrocavernous tuberculosis, less frequently from tuberculous bronchoadenitis, disseminated and focal tuberculosis, caseous pneumonia. Segmental cirrhosis was present in 15 patients, multisegmental and lobar cirrhosis in 19, and bilateral lung cirrhosis in 2. In 8 patients, pulmonary cirrhosis was accompanied by tuberculous empyema; in 8 more patients lobar cirrhosis was the metatuberculous syndrome of fibrocavernous tuberculosis. Evaluation of the diagnostic potentialities of CT in cirrhotic pulmonary tuberculosis revealed that the major CT semiotics of this clinical type was identical to the basic skialogic signs of routine X-ray study. However, unlike the latter that assesses mainly indirect X-ray signs of the cirrhotic transformation of lung tissue, such as reduced lung volumes, chest deformity, CT objectively detects morphological changes in cirrhosis, the presence and magnitude of specific and metatuberculous changes, interprets clinical and X-ray variants of this form of tuberculosis and its related pulmonary vascular alterations.