腹腔结核病46例

目的探讨儿童腹腔结核病的诊断方法,提高对该病的认识和诊断率。方法回顾性分析46例腹腔结核病患儿的临床资料。结果 46例腹腔结核病患儿中以上呼吸道感染、胃肠炎、消化不良等疾病收入院者38例,以肠梗阻、肺结核入院者分别有2例和3例,仅3例初诊即诊断为腹腔结核。46例均有腹部阳性体征,其中36例腹痛、腹胀,5例腹泻或便秘,8例浅表淋巴结大。41例行PPD试验,38例阳性。所有病例行腹部B超和胸部X线检查,B超均显示异常超声征象(100%),胸片显示肺结核38例(82.61%)。3例行浅表淋巴结活检,5例行腹腔探查手术,均获确诊。本组1例于急诊剖腹探查术后4 d死亡,余45例临床治愈。结论绝大多数腹腔结核病患儿早期以消化道症状为主要临床表现,易误诊。PPD试验和腹部B超检查是诊断的重要依据,胸部X线检查是协助诊断的重要手段。     

诊断困难的婴幼儿腹腔结核手术干预的价值

儿童结核以肺结核为主[1,2],婴幼儿腹腔结核文献罕有报道且诊断困难,但临床有增多趋势,现就本组病例一再引起诊断上混淆的原因结合文献对婴幼儿腹腔结核诊断难点、手术干预价值作一探讨,旨在提高对婴幼儿腹腔结核的认识。临床资料一、一般资料取自2000年8月~2004年3月经剖腹探查,得到病理确诊的3例婴幼儿病例资料。女2例,男1例;年龄27d~2岁;均接种过卡介苗(BCG),1例有TB接触史。间歇性腹痛伴发热2例,单纯发热1例。二、辅助检查3例患儿外周血白细胞均升高,1例高达62.1×109/L。均经多次查结核菌素纯蛋白衍化物(PPD)(-),抗TB抗体(-),痰液…     

结核抗体检测对儿童结核病的诊断价值

我们采用结明（MycoDotTM）结核病诊断（以下简称结明检测）和快速ELISA结核抗体检测（以下简称ELISA检测）两种结核抗体检测方法对82例儿童结核病病人血清进行检测，观察儿童结核病的诊断价值，现报告如下。材料和方法一、对象1．活动性儿童结核病病人82例，其中胸内和（或）肺门淋巴结核57例，原发综合征19例，结脑6例，均为菌明病人，年龄2a～14a。2．非结核病儿童36例，其中肺炎13例，支气管哮喘8例，呼吸道感染7例，腹泻8例，年龄2a～14a。3．均以国家第3版医药院校本科教材诊断标准进行诊断。所有病人均为1996年7月～1997年10月…     

儿童结核病免疫学诊断进展

结核病已经出现了几千年,而结核病的致病菌一直到1882年才被德国的科学家柯霍氏发现。在此期间结核病在全球蔓延,造成了无数人的死亡;即使在结核分枝杆菌被发现后的100多年里也有2亿多人死于结核病,迄今全球有1／3（约20亿）的人受到结核菌的感染,每年约1000万新发病例,每年约300万人死于结核病。     

腹腔结核

结核可以累及整个消化道.腹腔结核的临床表现形式多样,特别是结核性腹膜炎,常与其他疾病相混淆.     

儿童脑肿瘤30例诊断分析

目的：分析儿童脑肿瘤的特点,探讨其诊断和鉴别诊断方法。方法回顾性分析30例脑肿瘤患儿的临床资料。结果30例患儿中,男女比例为1．56∶1,平均年龄为5．20岁,肿瘤生长部位多见于后颅窝（53．6％）,其中星形细胞瘤最常见,临床表现为头痛、呕吐等颅高压症状,肢体活动障碍或功能失调,惊厥,病理征阳性和颅神经损害。CT检出率为93．3％,MRI检出率为100％。术前CT定性准确率为65．8％,MRI为77．6％。结论儿童脑肿瘤发病率男多于女,发生部位以后颅窝多见,早期症状及体征不典型,易漏诊误诊。MRI是儿童脑肿瘤重要的诊断方法,对儿童脑肿瘤的早期诊断尤为重要。     

儿童结核病诊断:附35例报告

为了探讨儿童结核病的发病规律及诊断方法，收集并分析了1995～2000年期间收治的35例儿童结核病的资料。35例中24例为外来流动人口，7例有结核病接触史，2例有长期激素治疗史，1例经HIV检测证实为艾滋病，并在随访1年后死亡。68．57％的患者存在肺外结核。PPD试验、抗结核抗体的阳性率分别为56．00％及57．14％，有28例接种过卡介苗。I～V型分别为14．29％、14．28％、8．57％、17．14％和45．72％。提示目前小儿结核病的诊断仍需结合流行病学、临床表现、影像学检查及实验室检查进行综合判断；人口流动为结核病发病率上升的主要原因之一；小儿结核病易血行播散并累及浆膜腔；卡介苗对结核病的预防作用有限。     

浅谈儿童结核病的诊断（附三例临床分析）

目的 提高对儿童结核病诊断的认识,避免误诊或漏诊.方法 回顾性分析我科2011年收治的3例儿童结核病的临床特点、相关实验室检查、影像学资料及诊疗经过.结果 3例患儿均为男性,年龄5～12岁.例1为肺部结核感染,行肺活检见到片状干酪样坏死组织.例2为结核性脑膜炎,头颅MRI示脑膜广泛增厚强化,脑组织见结核球.例3为肾上腺结核,行腹部CT提示肾上腺内不规则密度灶,有钙化点,肠系膜多发淋巴结.均在抗结核治疗后病情缓解.3例患儿均无明确结核接触史,无明显结核中毒症状,结核菌素试验、结核抗体及病原学检查均为阴性,最后根据影像学特征或病理检查结果,结合抗结核治疗的效果来诊断,均为临床诊断病例.结论 儿童结核病常无特征性表现.在结核菌素试验及病原学检查阴性时,影像学表现可作为诊断的重要参考,必要时可行诊断性治疗确立临床诊断.     

儿童结核病的实验室诊断

儿童结核病属载菌量小的疾病,且小儿痰标本留取困难,因此痰涂片或结核菌培养阳性率低。获取合格标本和多次送检可提高阳性率。结核菌抗体检测简便易行,特别是干扰素分析试验可区分卡介苗接种和其他分枝杆菌感染,是诊断结核病的重要方法。     

Diagnostic dilemmas in abdominal tuberculosis in children

The authors review 45 pediatric patients with intra-abdominal tuberculosis (ATB) treated between May 1990 and April 1998. The diagnosis was confirmed histologically or by positive culture for Mycobacterium tuberculosis. Clinical presentation was with an abdominal mass (12), subacute obstruction (11), ascites (5), mass and ascites (4), peritonitis (4), and 9 unusual presentations. Mantoux tests were positive in 68% of patients tested. There were radiologic features suggestive of pulmonary TB in 29 patients (64%); abnormal abdominal radiographs were recorded in 21 (47%). Lymphadenopathy was noted on abdominal ultrasound in 23 of 30 patients (77%) and on computed tomography scan in a further 3 of 8 patients investigated. Ascitic fluid adenosine deaminase (ADA) levels were greater than 30 IU/l in 3 of 4 patients (75%), suggesting ATB. All 28 patients screened for human immunodeficiency virus were negative. A surgical procedure was performed in 39 patients. 29 (74%) had an elective diagnostic laparotomy for tissue diagnosis. One (3.4%) developed a postoperative intra-abdominal abscess. Ten (26%) presented with complications requiring surgical intervention including perforated viscus, segmental bowel resection, strictureplasty, adhesiolysis, or ileostomy. One of the latter died due to sepsis after having complications of persistent intestinal obstruction and cecal perforation. The authors recommend an aggressive approach to patients with suspected ATB in order to obtain an early definitive diagnosis, prevent complications, and reduce morbidity and mortality. They emphasize the importance of tissue diagnosis and confirmation by culture. Accepted: 24 November 1999     

儿童腹胀的诊治要点

儿童腹胀是临床常见的消化道症状,既可以是消化系统疾病本身表现,亦可以是全身性疾病或其他系统的伴随或继发症状.本文对儿童腹胀的病因、诊断要点、鉴别诊断、治疗建议等进行一一阐述.临床医生应仔细、谨慎评估儿童腹胀患者,警惕急腹症,综合判断.     

Abdominal tuberculosis in Indian children

During the period 1980–1991, 166 cases (121 surgically explored and 45 treated conservatively) of abdominal tuberculosis in children were encountered at the Children's Hospital, Institute of Medical Sciences, Banaras Hindu University. Various types of presentations and their management are discussed in the light of pertinent literature.     

Abdominal tuberculosis in children — surgical management

During the period 1980–1989, 95 patients, mean age 5 years, with abdominal tuberculosis (ATB) were seen at the Red Cross Children's Hospital. Eighty per cent were malnourished. Apart from fever, loss of weight, and failure to thrive, symptoms of abdominal pain, vomiting, and diarrhoea predominated. Abdominal distension (86%) and a palpable mass (57%) were the most common physical findings. Sixty-three per cent had radiological evidence of chest disease. Abdominal ultrasound was useful in identifying ascites and distribution of lymph node masses. Fifty of the 95 patients were managed on the surgical unit and the predominant involvement was: peritoneal 21, nodal 15, enteric 11, and undetermined 3. Thirteen of this group developed one or more complications — perforation (4), obstruction (7), abscess or fistulae (5), and haemorrhage (1). Surgery involved diagnostic laparotomy, extra-abdominal biopsy, and management of the complications. Emergency surgery was conservative. Definitive surgery for stricture-plasty, resection, and stoma closure was delayed at least 8 weeks to allow for chemotherapeutic effect. Uncomplicated TB responded rapidly to therapy. There were no deaths in this group. Thirty-seven of the 45 medical cases made an uncomplicated recovery on anti-TB therapy. Three died due to generalised disease, 5 had complications (chylous ascites 2, protein-losing enteropathy 3) and 3 had relapse of disease due to poor compliance. The morbidity and mortality of this ubiquitous disease can be greatly reduced by timely diagnosis, which often requires early recourse to diagnostic laparotomy, and appropriate surgery and supportive care for complicated disease. Offprint requests to: A. J. W. Millar     

儿童腹部损伤的诊断与治疗

目的 探讨儿童腹部损伤的保守治疗及手术探查的指征,提高儿童腹部损伤的诊疗水平.方法 回顾性分析我院89例腹部损伤患儿的临床资料,根据损伤部位情况进行分类,并逐一对其进行分析.结果 (1)89例腹部损伤患儿中,25例肝损伤,1例行剖腹探查;48例脾损伤,46例保守治疗,1例行脾切除术,1例予修补;14例胃肠道损伤,4例急诊剖腹探查,1例住院4 d后出现迟发穿孔;8例胰腺损伤,6例肾、肾上腺挫伤,予保守治疗;1例子宫、膀胱损伤,急诊手术治疗.(2)与成人不同,肝脾损伤患儿绝大多数经保守治疗能治愈,静脉补液后输血仍超过40 ml/kg,且血压不稳定者应及时手术探查.(3)CT检查对怀疑有胃肠道损伤,而不宜行腹部X线立位平片者有重要临床意义,合并气腹或腹胀明显加重,或出现腹膜炎表现的患儿,应及时手术探查,尤其注意迟发消化道穿孔的可能.(4)排除有胰腺横断的患儿,胰腺损伤多应保守治疗.(5)膀胱及子宫损伤患儿,外伤多较严重,需及时剖腹探查.结论 基层医院儿童腹部损伤应高度重视,实质脏器损伤导致的内出血是患儿死亡的最主要原因,空腔脏器损伤延误诊治是导致患儿死亡的另一重要原因,因此,早期准确诊断,积极治疗,以及综合处理其他严重的合并伤、并发症是成功救治该类患儿的关键.     

Colonoscopy in the diagnosis of abdominal tuberculosis in children

Childhood abdominal tuberculosis has protean manifestations and remains a difficult diagnosis problem, often requiring surgery for pathological confirmation. Colonoscopy, however, can now be performed with safety in children and appears to offer a new and better alternative to surgery. An earlier experience confirmed its value in the management of ileocaecal tuberculosis as it provided histological proof and bacteriological information to guide chemotherapy, avoiding the need for anaesthesia and laparotomy. However, colonoscopy hasn't been helpful in the diagnosis of the 'exudative' type of abdominal tuberculosis.     

Diagnosis and treatment of benign pneumoperitoneum in children

目的 探讨小儿良性气腹的诊断及治疗,以与常见的外科性气腹鉴别.方法 回顾性分析本院2000年2月至2010年11月收治的8例良性气腹患儿临床资料,总结其诊断及治疗方法.结果 8例患儿均采用禁食、抗感染、补液、腹腔穿刺、密切观察等保守支持治疗,腹腔游离气体消失后顺利出院.结论 良性气腹的诊断主要依靠患儿的临床症状、仔细的腹部查体、腹部X线片结合腹腔穿刺,并排除空腔脏器穿孔而确诊.保守治疗即可治愈,要注意与外科性气腹鉴别以避免不必要的手术探查.     

纤维支气管镜诊断儿童支气管结核的研究

目的　探讨儿童支气管结核 (EBTB)的纤维支气管镜 (纤支镜 )诊断及分型。方法　回顾性总结、分析临床治疗不顺利的肺结核或可疑肺结核的住院患儿 110例 ,均经纤支镜诊查 ,归纳EBTB病变在纤支镜下表现 ,并分型为 :粘膜型、干酪型、管腔型和混合型。 110例均摄胸部X线片 (其中做胸部CT检查 6 2例 ) ,追踪临床诊疗过程和最终诊断 ,以验证纤支镜诊断。再评估纤支镜在儿童EBTB诊查中的作用 ,提出EBTB诊断标准。结果　纤支镜诊断 10 8例EBTB ,其中混合型 78例、粘膜型 18例、管腔型 9例、干酪型 3例。临床合并各型儿童肺结核 91例。在纤支镜确诊的 17例EBTB中 ,胸部X线片均未提供特异性结核证据 ,气道分泌物结核菌阳性 15例。本文结核菌阳性率为 5 3%。结论　儿童EBTB并非少见 ,其诊断在临床有重要意义 ;儿童EBTB可以原发 ;本文试行的儿童EBTB分型方法简便易行。纤支镜是诊断EBTB的必需工具。     

腹部闭合伤致儿童胰腺外伤的诊治探讨

目的 探讨儿童腹部闭合性损伤导致胰腺外伤的病因及诊断和治疗方法.方法 回顾性分析我院1999年1月至2008年5月间收治14例闭合性腹部损伤导致胰腺外伤患儿的临床资料.结果 男11例,女3例,男∶女=3.7∶1.致伤原因依次为自行车把致伤5例、交通事故4例、踢伤或殴伤3例、跌伤2例.临床表现有腹痛、腹部压痛、白细胞及血清淀粉酶升高和发热.实验室检查14例均有不同程度白细胞升高.10例(71.5%)血清淀粉酶升高,二者升高水平与胰腺损伤程度无关;重复血清淀粉酶值测定对胰腺外伤具有诊断意义.11例(78.6%)CT检查发现胰腺损伤6例(54.5%),5例CT检查正常但剖腹探查胰腺外伤2例;12例B超检查发现胰腺损伤8例;内镜逆行胰胆管造影(ERCP)检查1例.保守治疗成功9例,包括轻微损伤6例,远端胰管损伤1例,入院时有胰管损伤但未发现2例.剖腹探查及胰腺外引流术5例.胰腺假性囊肿形成后手术4例.结论 胰腺外伤在儿童腹部闭合性损伤中并不常见.诊断以血清淀粉酶升高、CT及B超检查为主,少数需剖腹探查.白细胞及血清淀粉酶升高水平与胰腺损伤程度无关.重复血清淀粉酶测定及CT检查对胰腺外伤具有诊断意义.大多数胰腺创伤包括胰管近端损伤儿童可以先保守治疗而不是冒风险手术干预,如果形成假性囊肿再后期引流.胰管远端损伤(Ⅲ级)最好选择保脾胰尾切除术.剖腹探查术中发现轻微胰腺损伤而采用腹部闭式引流措施意义不大.     

儿童气管支气管结核的临床及支气管镜下特征分析

目的 总结气管支气管结核（tracheobronchial tuberculosis,TBTB）患儿临床和支气管镜下特点,并分析气道闭塞或瘢痕狭窄的影响因素。 方法 回顾性收集TBTB患儿的临床资料,根据随访1年内最后1次支气管镜结果分为气道闭塞或瘢痕狭窄组（n=34）和无气道闭塞或瘢痕狭窄组（n=58）。采用多因素logistic回归分析探讨儿童TBTB遗留气道闭塞或瘢痕狭窄的影响因素,使用受试者工作特征（receiver operating characteristic,ROC）曲线分析影响因素对儿童TBTB遗留气道闭塞或瘢痕狭窄的预测价值。 结果 92例TBTB患儿主要症状为咳嗽（90%）、发热（68%）;<1岁组患儿气促、喘息发生率高于其他年龄组（P<0.008）。胸部CT常见改变为纵隔或肺门淋巴结肿大（90%）、气管支气管狭窄或堵塞（61%）。TBTB镜下以淋巴结瘘型为主（77%）。所有患儿均行介入治疗,有效率为84%。随访1年,34例患儿遗留气道闭塞或瘢痕狭窄。气道闭塞或瘢痕狭窄组比无气道闭塞或瘢痕狭窄组TBTB的诊断时间和启动介入治疗时间均显著延迟（P<0.05）。多因素logistic回归分析显示TBTB诊断时间与患儿遗留气道闭塞或瘢痕狭窄密切相关（P<0.05）。ROC曲线分析发现TBTB诊断时间取92 d是预测TBTB患儿遗留气道闭塞或瘢痕狭窄的最佳截断值,曲线下面积为0.707,灵敏度为58.8%,特异度为75.9%。 结论 TBTB临床表现无特异性,<1岁患儿临床症状更重。对胸部影像学提示气道受累的肺结核患儿应警惕TBTB发生。TBTB诊断延迟与气道闭塞或瘢痕狭窄发生相关。 ［中国当代儿科杂志,2023,25（4）：381-387］