大肠结核20例误诊分析

目的：总结大肠结核临床表现的复杂性，误诊原因和诊断策略，方法：对20例术前被误诊的大肠结核的临床资料，诊断难点及诊治过程进行回顾性分析。结果：腹痛、腹块和大便习惯改变是最主要的临床表现，大肠结核易误诊为大肠肿瘤、克罗恩病和阑尾周围脓肿，17例剖腹手术者术中仍有10例（58．8％）被误诊为肿瘤和克罗恩病，即使术后在病理学报告前仍有多数不能确诊。3例其他方法诊断。全消化道造影，结肠镜及细针抽吸细胞学（FNAC）和腹腔镜等检查将能提高其诊断率，剖腹探查检是最后采用的诊断方法，但确诊主要依赖于病理学检查。 结论：大肠结核的临床表现和影像学检查均缺乏特异性，误诊率高，加强临床医师对该病的全面认识是提高诊断水平的重要环节。只要诊断明确，治疗上并不困难；若能术前确认，则可避免一些不必要的手术，对于大肠结核，不论病灶切除与否，6个月的抗痨治疗是有效的。

The analysis of 20 misdiagnosed cases of large intestine tuberculosis

Objective To summarize the complication of clinical characteristics, factors causing misdiagnosis, and diagnosis of large intestine tuberculosis (LIT). Methods The data of twenty cases of LIT misdiagnosed preoperatively in our hospital were analyzed retrospectively. The difficulties of LIT diagnosis and management were studied and analyzed. Results Abdominal pain, mass, and the alteration of stool habit were the most common symptoms. LIT was most commonly confused with malignant tumor, Crohn's disease, and periappendicular abscess. Ten of 17 patients, who were performed exploratory laparotomy, were misdiagnosed as tumor or Crohn's disease. Most of our cases were not definitively diagnosed until the histopathologic examination after surgery. Three cases were diagnosed by other methods. Gastrointestinal X ray series, colonoscopy, endoscopic fine needle aspiration cytology(FNAC) and laparoscopic exploration may improve the diagnosis. Exploratory laparotomy with biopsy was the final procedure for diagnosis. Final diagnosis mainly depends on histology. Conclusions LIT lacks special clinical manifestations and has a high misdiagnosis rate. But if correct diagnosis is established, most patients can be cured and unnecessary exploratory laparotomy can be avoided. Six months antituberculosis treatment is effective for LIT whether the lesion is excised or not.