外科治疗腹腔结核107例临床分析  

Clinical Analysis of Surgical Treatment of Abdominal Tuberculosis

作　　者：徐慧海[1] 李亚斋 李姿健[1] 李明珠[1] 杜秀然[1] 齐海亮[1] Xu Huihai;Li Yazhai;Li Zijian(Hebei Provincial Chest Hospital,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院,河北石家庄050041

出　　处：《四川医学》2020年第11期1117-1120,共4页Sichuan Medical Journal

基　　金：2019年度河北省卫健委青年科技课题(编号:20191031)。

摘　　要：目的探讨腹腔结核外科治疗的临床疗效。方法回顾性分析我院2010年1月至2019年1月腹腔结核行手术治疗的107例患者临床资料,包括急诊手术组31例(28.97%),择期手术组76例(71.03%)。分析患者手术时机、手术方式、术后并发症及治疗、随访结果等资料。结果急诊手术组31例中,行肠切除+肠造瘘术30例(96.77%),行肠切除+肠吻合术1例(3.23%);术后切口感染11例(35.48%),肠瘘7例(22.58%),死亡2例(6.45%)。择期手术组76例中,行肠切除+肠造瘘手术13例(17.11%),肠切除+肠吻合术32例(42.11%),单纯肠黏连松解术31例(40.79%);术后切口感染8例(10.53%),肠瘘5例(6.58%),无死亡。肠瘘(12/107)及切口感染(19/107)患者中,除2例死亡及1例行再次手术外,经抗感染、引流、换药等治疗均预后良好。肠切除+肠造瘘手术(43/105)均在4~6个月后行2期还纳手术,预后良好。8例失访,97例患者随访18~24个月,随访期内36例患者有间断轻微腹痛,其他患者一般情况均良好。结论外科治疗是腹腔结核治疗的重要方案,外科介入可提高腹腔结核的诊断率,降低患者术后并发症的发生率和死亡率。Objective To explore clinical efficacy of surgical treatment of abdominal tuberculosis.Methods From January 2010 to January 2019,107 patients with abdominal tuberculosis undergoing surgical treatment in our hospital were retrospectively analyzed,including 31 cases(28.97%)in emergency surgery group and 76 cases(71.03%)in elective surgery group.Surgical time,30 cases(96.77%)underwent bowel resection+enterostomy,and 1 case(3.23%)underwent bowel resection+enterostomy.There were 11 cases(35.48%)of wound infection,7 cases(22.58%)of intestinal fistula,and 2 cases(6.45%)died.In elective surgery group,13 cases(17.11%)underwent bowel resection+enterostomy,32 cases(42.11%)underwent bowel resection+bowel anastomosis,and 31 cases(40.79%)underwent simple intestinal adhesion lysis.There were 8 cases(10.53%)of incision infection,5 cases(6.58%)of intestinal fistula,and no deaths.In patients with intestinal fistula(12/107)and incision infection(19/107),prognosis was good by anti-infection,drainage and dressing changes,except for 2 deaths and 1 reoperation.Intestinal resection+intestinal fistula surgery(43/105)were performedtwo-stage return surgeryat 4 to 6 months with good prognosis.8 cases were lost to follow-up,and 97 patients were followed up for 18-24 months.During follow-up period,36 patients had intermittent mild abdominal pain,and others were generally in good condition.Conclusion Surgical treatment could be an important plan to treat abdominal tuberculosis.Surgical intervention could improve diagnosis rate and reduce postoperative complications incidence and mortality.

关 键 词：急诊手术 择期手术 腹腔结核 并发症 死亡率 

分 类 号：R524[医药卫生—内科学]