儿童腹腔结核病30例诊断分析

目的 提高对儿童腹腔结核病的认识和诊断水平.方法 回顾性总结北京儿童医院住院治疗的30例腹腔结核病例的临床特点、诊断过程及预后资料,探讨各种诊断方法的临床意义.结果 20例患儿初诊为上呼吸道感染、胃肠炎、消化不良等疾病,另6例诊断为肺结核,初诊即诊断为腹腔结核者仅4例.30例中21例(70%)有腹痛、腹胀,腹泻或便秘等症状;均有腹部阳性体征(腹腔积液1O例次,腹部揉面感9例次,腹部压痛8例次,腹部包块4例次,肝脾肿大3例次).24例伴发腹腔外结核.PPD阳性28例(93%),腹部超声结果全部异常.剖腹探查3例,结肠镜活检2例,均获确诊;24例获临床诊断患儿经正规抗结核治疗效果明显.结论 儿童腹腔结核病初诊时容易被误诊,应引起重视;大多数患儿具有消化道症状和体征;腹腔外结核的存在是协助诊断的重要依据;PPD检查和腹部超声检查是诊断的重要依据;结肠镜和剖腹探查能够获得确切诊断证据.

Diagnosis of abdominal tuberculosis in children

Objective To improve the recognition and diagnosis of abdominal tuberculosis(TB)in children.Method The data from 30 cases with abdominal TB hospitalized in Being Children's Hospital were analyzed retrospectively.The clinical significance of various tests was discussed respectively.Result Twenty of the 30 cases were misdiagnosed as having upper respiratory tract infection,gastroenteritis,indigestion,and only 6 cases were diagnosed as pulmonary tuberculosis while the diagnosis of abdominal TB was made in iust 4 cases at initial consultation.Twenty-one cases(70%)experienced the symptoms of abdominal pain or distension,diarrhoea,or constipation.The positive abdominal signs existed in all children including doughy sensation(9 cases),tenderness(8 cases),mass(4 cases),and hepatosplenomgaly (3 cases).Extraabdominal TB was found in 24 children,the positive PPD and abnormal ultrasonic image were seeu in 93%and 100% of the cases,respectively.The exploratory laparotomy and colonoscospic biopsy confirmed the diagnosis in 3 and 2 cases,respectively.Twenty-four children received systematic treatment with good results.Conclusion The abdominal TB in children which is easily misdiagnosed in it's early stage usually consisted of gastrointestinal symptoms and signs.The TB beyond the abdomen can be a clue for making correct diagnosis.PPD and ventral ultrasonic examination are important for ultimate clinical diagnosis while colonoscopy,and laparotomy can provide pathological evidence.