内镜、病理检查与DNA检测诊断大肠结核18例分析  

Analysis of 18 Cases of Large Intestine Tuberculosis by Polymerase Chain Reaction、Enteroscopy and Pathological Examination

作　　者：周桂霞[1] 龚锦文 付桂珍[1] 程燕林[1] 

机构地区：[1]九江市第一人民医院,江西九江332000

出　　处：《江西医学院学报》2006年第1期92-94,99,共4页Acta Academiae Medicinae Jiangxi

摘　　要：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18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。大肠结核较易误诊为大肠肿瘤、克罗恩病、淋巴瘤和阑尾周围脓肿。4例剖腹手术者术中仍有2例(50%)被误诊为肿瘤和克罗恩病,即使活检或术后在病理学报告前仍有多数不能确诊。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,剖腹探查活检是最后采用的诊断方法。但确诊主要依赖于病理学检查和结核杆菌DNA检测。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;若能术前确诊,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个月的抗结核治疗是有效的。Objective To summarize the complication of clinical characteristics, factors causing misdiagnosis,and diagnosis of large intestine tuberculosis （LIT）. Methods The data of eighteen cases of LIT diagnosed 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, lymphoma and periappendicular abscess. There were 2 of 4 patients,who were performed operation. Most of our cases were not definitively diagnosed until the histopathologic examination after surgery and polymerase chain reaction（PCR）. Other methods might improve the diagnosis such as Gastrointestinal X-ray series, colonoscopy, endoscopic fine needle aspiration cytology（FNAC）and surgery. Surgical operation with biopsy and PCR were the final procedure for diagnosis. Final diagnosis mainly depended on histology and TB-DNA-PCR. Conclusion LIT lacks special clinical manifestations and has a high misdiagnosis rate. But,if correct diagnosis is established,most patients can be cured and unnecessary surgical operation can be avoided. Antituberculosis treatment for months is effective on LIT no matter the lesion is excised or not.

关 键 词：大肠结核 诊断 治疗 

分 类 号：R574.6[医药卫生—消化系统]