腹腔结核合并肠梗阻的外科治疗探讨(附112例报告)  

Surgical treatment of abdominal tuberculosis and intestinal obstruction: a report of 152 cases

作　　者：曹志宇[1] 何建苗[1] 张庆军[1] 吕刚[1] 史玉琪[1] 杨波[1] 

机构地区：[1]解放军309医院普外科,北京100091

出　　处：《解放军医学杂志》2016年第12期1051-1053,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨腹腔结核合并肠梗阻的外科治疗经验。方法回顾性分析2010年1月-2015年12月手术治疗的112例腹腔结核合并肠梗阻的病例资料。结果 112例患者中完全性梗阻96例,其中回盲部结核29例(致回肠穿孔12例)、广泛粘连39例、粘连致肠管绞窄28例;不全性梗阻16例,其中回盲部结核6例、肠系膜淋巴结结核致部分粘连6例、肠粘连成角4例。手术治愈106例,其余6例再次出现梗阻,经抗结核治疗后行二次手术治愈。术后并发肠瘘5例,其中2例因感染加重导致多脏器功能衰竭死亡,3例经充分引流、抗结核及营养支持治疗后痊愈。结论外科手术是治疗腹腔结核合并肠梗阻的有效方法,术前经充分多学科会诊制定合理的抗结核治疗和营养支持方案是减少术后并发症、彻底治愈的关键。Objective To summarize the experiences in surgical treatment of abdominal tuberculosis and intestinal obstruction. Methods The clinical data were retrospectively analyzed of surgically treated 112 cases of abdominal tuberculosis and intestinal obstruction from Jan. 2010 to Dec. 2015. Results Of the 112 cases, 96 were diagnosed with complete intestinal obstruction, including 29 cases of ileocecal tuberculosis （12 cases of ileum perforation）, 39 cases of severe adhesions, and 28 cases of strangulated ileus caused by adhesive band; 16 cases were incomplete ileus, including 6 cases of ileocecal tuberculosis, 6 cases of part adhesions caused by mesenteric lymph node tuberculosis, and 4 cases of angulation adhesion. A hundred and six cases were cured surgically. Six cases were obstructed again and cured after antituberculotic treatment. Five cases were with intestinal fistula after surgery, of whom 2 cases died of MODS induced by aggravation of infection, and 3 cases were cured and recovered after antituberculotic and nutritional support treatment through thorough drainage. Conclusions The surgical treatment as early as possible is recommended for the patients with abdominal tuberculosis and intestinal obstruction. Preoperative formulation through full multidisciplinary team （MDT） consultation of reasonable anti-tuberculosis treatment and nutritional support scheme is the key to complete recovery and reduce of postoperative complications.

关 键 词：腹腔结核 肠梗阻 消化系统外科手术 

分 类 号：R574.2[医药卫生—消化系统] R52[医药卫生—内科学]