43例腹腔结核并发肠穿孔患者的外科治疗效果分析  

Surgical therapy in 43 abdominal tuberculosis patients complicated with intestinal perforation

作　　者：徐慧海[1] 张珊珊 李姿健[1] 齐海亮[1] 杜秀然[1] 苏宏伟[1] XU Hui-hai;ZHANG Shan-shan;LI Zi-jian;QI Hai-liang;DU Xiu-ran;SU Hong-wei(The 2nd Department of Thoracic Surgery,Hebei Chest Hospital,Shijiazhuang 050048,China)

机构地区：[1]河北省胸科医院胸二科,石家庄050048 [2]河北省肿瘤医院(东院)手术室

出　　处：《中国防痨杂志》2019年第3期266-271,共6页Chinese Journal of Antituberculosis

摘　　要：目的分析外科治疗腹腔结核致肠穿孔患者的临床情况。方法收集河北省胸科医院2008—2016年收治的43例经手术病理确诊的腹腔结核伴肠穿孔患者,所有患者经胸部X线摄影或CT扫描检查均为可疑肺结核。描述性总结分析其术前临床表现、实验室检测及各项检查、术中探查及手术方式、术后治疗及并发症、治疗结果、随访结果等临床资料。结果43例患者术后病理证实均存在腹腔结核,其中32例非急诊患者临床诊断明确者18例,11例急诊患者术前均未明确诊断;术中探查均存在肠穿孔,其中术前考虑单纯肠梗阻3例、肠梗阻伴肠穿孔30例(8例急诊和22例非急诊患者术前经诊断性穿刺诊断肠穿孔)、单纯肠穿孔10例。40例(93.0%)因病变范围广泛、感染严重行Ⅰ期肠切除+造瘘术,其中12例切口感染患者经切口换药、引流后治愈;8例发生肠瘘患者除2例(保守治疗、二次手术各1例,年龄均>65岁)因多脏器功能衰竭死亡外,余6例经治疗后预后良好;2例发生肠梗阻患者1例行二次手术、1例保守治疗后治愈;余18例患者造瘘术后恢复良好。2例(回盲部肿物伴穿孔1例,腹腔感染较轻1例)行回盲部切除+回结肠吻合术;1例因近回盲部出现回肠局部单一穿孔,且同时并发腹腔淋巴结结核、局部淋巴结节和穿孔部位回肠粘连,但腹腔感染较轻的患者行回肠部分切除+肠吻合术,术后无严重并发症。抗结核治疗12个月后均治愈停药。37例患者停药后随访18~24个月,4例患者失访,随访期内16例患者有间断轻微腹痛症状,其他患者一般情况均良好。结论腹腔结核伴肠穿孔是严重的消化道结核并发症,规范的抗结核药物治疗是基础,而外科手术是有效治疗的首选方式,治疗效果良好。Objective To explore the effect of surgical treatment for abdominal tuberculosis complicated with intestinal perforation.Methods Forty-three abdominal tuberculosis patients complicated with intestinal perforation who underwent surgery in Hebei Chest Hospital from 2008 to 2016 were included in the study. All patients were suspected of lung tuberculosis by chest X-ray or CT scan. The clinical data were descriptively summarized and analyzed, including preoperative clinical manifestations, laboratory tests and examinations, intraoperative exploration and surgical procedures, postoperative treatment and complications, treatment outcome, and follow-up data.Results All of the 43 patients were confirmed as abdominal tuberculosis via postoperative pathology examination. Eighteen out of the 32 non-emergency patients were clinically diagnosed before surgery, whereas all of the 11 emergency patients were not diagnosed before operation. All patients had intestinal perforation confirmed by intraoperative exploration, of whom 3 cases were preoperatively diagnosed with intestinal obstruction, 30 cases were intestinal obstruction with intestinal perforation (8 emergency patients and 22 non-emergency patients were diagnosed with perforation by diagnostic puncture before operation), and 10 cases were intestinal perforation. Forty patients (93.0%) underwent stage I ileostomy due to a wide range of lesions, among whom, 12 patients with incision infection were cured after incision dressing and drainage;2 of the 8 patients with intestinal fistula died of multiple organ failure (one received conservative treatment and one underwent secondary surgery;both >65 years old), and the remaining 6 cases had good outcome after treatment;2 cases of intestinal obstruction were cured, one by secondary surgery and one by conservative treatment;and the remaining 18 patients recovered well after ileostomy. In addition, 2 cases (one with ileocecal mass with perforation and one with mild abdominal infection) underwent ileocecal resection and ileocolon a

关 键 词：结核 胃肠 肠穿孔 外科手术 治疗结果 

分 类 号：R52[医药卫生—内科学] R656[医药卫生—临床医学]