肠结核的诊断及外科治疗37例报告

目的探讨肠结核诊断及内、外科治疗方法。方法回顾性病例分析及文献综述。结果我院１９８３～１９９７年共收治３７例肠结核病例，其中２６例行钡餐阳性率１００％（２６／２６）、钡灌肠２４例阳性率１００％（２４／２４）和纤维结肠镜１７例阳性率９４１％（１６／１７）。单纯内科治疗２１例，１６例因并发症或误诊接受外科治疗，１３例切除病变肠管，３例行开腹活检或穿孔修补术。内科治疗组，抗结核时间２０个月，复发４例；切除病变肠管的１３例患者平均抗结核时间１０个月，没有复发；行开腹活检或穿孔修补的３例患者抗结核时间１９个月，１例复发。结论钡餐、钡灌肠、纤维结肠镜是较为有效的检查方法，对于伴有腹部并发症的患者及早积极采用外科手术治疗切除病变肠管及术后抗结核治疗，从治疗时间、治疗复发等方面可能优于单纯内科保守治疗。

Diagnosis and surgical treatment for intestinal tuberculosis,a report of 37 cases

Objective To evaluate the diagnosis and surgical treatment of intestinal tuberculosis.Methods The clinical data of 37 cases diagnosed as intestinal tuberculosis in our hospital between 1983 and 1997 were retrospectively analyzed and literature was reviewed.Twenty one cases received conservative therapy, laparotomy and biopsy were performed in 3 cases,and bowel resections in 13 cases. Results The positive rates of barium meal,barium enema and fibrocolonoscopy was 100% (26/26),100% (24/24),and 94% (16/17) respectively.Twenty one cases underwent conservative therapy,16 received laparotomy because of misdiagnosis or complications,among them 13 had resection of the diseased gut,3 had biopsy or suture closure of the perforation.The duration of antituberculosis treatment in the medical group averaged 20 months with recurrence developed in 4 cases.The average duration of antituberculosis therapy was 10 months and without recurrence in 13 patients undergoing resection of the diseased gut,while the duration of antituberculosis lasted for 19 months with recurrence in one in the 3 undergoing laparotomy and biopsy.Conclusions Barium meal,barium enema and fibrocolonoscopy are first live measures for diagnosis.Patients with abdominal complications should receive bowel resection and prompt initiation of anti tuberculosis medications, and the result is better than medical treatment judged from the therapeutic courses and tuberculosis recurrence.