结核性肛周脓肿延误诊断临床分析(附5例报告)  

Clinical analysis of delayed diagnosis of 5 cases of tuberculous perianal abscess

作　　者：刘昕 王志超[2] LIU Xin;WANG Zhi-chao(Department of Infectious Diseases,Aviation General Hospital,Beijing 100012,China)

机构地区：[1]航空总医院感染疾病科,北京100012 [2]航空总医院普外科,北京100012

出　　处：《中国防痨杂志》2020年第5期527-528,共2页Chinese Journal of Antituberculosis

摘　　要：2015年12月至2017年12月,航空总医院普外科收治的320例肛周脓肿患者中5例患者术后30 d内切口未愈合,最终诊断为结核性肛周脓肿;其中3例并发肺结核,给予2R-H-E-Z/4R-H-E抗结核药物化疗方案治疗后,切口均愈合,平均愈合时间(25.5±3.6)d,无复发。分析延误诊断原因主要为:结核性肛周脓肿临床较少见,临床表现缺乏特异性,医务人员对此病的认识不足,未对患者病史进行详细分析,未进行脓液抗酸杆菌检查及肛周病变组织病理学检查。对于肛周脓肿的患者,应仔细询问患者病史,常规进行脓液分泌物抗酸杆菌检查、组织病理学检查。确诊为结核性肛周脓肿后应给予规范抗结核药物化疗方案治疗6个月至1年。From December 2015 to December 2017,among the 320 patients with perianal abscess treated in the department of general surgery of Aviation General Hospital,5 patients’ incisions failed to heal within 30 days after surgery.They were finally diagnosed as tuberculous perianal abscess among whom 3 cases got pulmonary tuberculosis too.After 2 R-H-E-Z/4 R H-E anti-tuberculosis treatment,all incisions were healed,with an average healing time(25.5±3.6) d,and no recurrence.Main reasons for the delayed diagnosis were:tuberculous perianal abscess was relatively rare clinically;lack of specificity in clinical manifestations;lack of understanding of the disease among medical staff;no detailed analysis of patients’ medical history;no examination of acid-fast bacilli in pus secretion and histopathological examination of perianal lesions.For patients with perianal abscess,we should inquire about the patient’s medical history carefully,and undertake routine examination of acid-fast bacilli in pus secretion and histopathological biopsies.Standard anti-tuberculosis treatment should be given for 0.5 to 1 year after diagnosis of tuberculous perianal abscess.

关 键 词：脓肿 结核 肛门疾病 延误诊断 结果与过程评价(卫生保健) 

分 类 号：R52[医药卫生—内科学]