不同类型腹腔结核Ⅰ期手术疗效分析  

Analysis of the effect of stage Ⅰ operation for different types of abdominal tuberculosis

作　　者：刘鑫 郭乐 李军孝 陈其亮 仵倩红 Liu Xin;Guo Le;Li Junxiao;Chen Qiliang;Wu Qianhong(Shaanxi Tuberculosis Prevention and Control Hospital,Xi’an 710100,China)

机构地区：[1]陕西省结核病防治院,西安710100

出　　处：《结核与肺部疾病杂志》2022年第5期372-377,共6页Journal of Tuberculosis and Lung Disease

摘　　要：目的:探讨不同类型腹腔结核Ⅰ期手术的治疗效果。方法:收集2016年1月1日至2020年6月30日陕西省结核病防治院诊治的经细菌学或病理学确诊的75例腹腔结核手术患者的临床资料,根据腹腔结核是否累及≥2个腹腔脏器将患者分为单纯组(37例)和复合组(38例),比较两组患者手术情况、术后并发症发生情况,以及手术疗效。结果:两组患者均采用Ⅰ期手术治疗,单纯组11例肠结核患者行回盲部切除及盲肠末端、升结肠端端吻合术,23例结核性腹膜炎患者行腹腔结核脓肿病灶清除术,3例腹腔淋巴结结核患者行肠系膜淋巴结结核及腹膜后淋巴结结核病灶清除术;复合组4例肠穿孔患者行穿孔修补+腹腔脓肿清除+肠粘连松解术,15例肠结核合并结核性腹膜炎患者行回盲部肠切除吻合+腹腔脓肿清除+肠粘连松解术,19例肠结核合并结核性腹膜炎及腹腔淋巴结结核患者行肠切除吻合+腹腔脓肿清除+肠系膜及腹膜后淋巴结清除+肠粘连松解术。复合组术中出血量[(1271.84±66.28)ml]、手术时间[210.0(145.0,307.5)min]和术后引流量[(1200.79±55.68)ml]均高于单纯组[(594.32±35.92)ml、80.0(60.0,90.0)min和(711.35±29.08)ml],差异均有统计学意义(t=―8.986,P<0.001;Z=―6.839,P<0.001;t=―7.791,P<0.001)。单纯组不完全梗阻发生率为16.2%(6/37),低于复合组(63.2%,24/38),差异有统计学意义(χ^(2)=17.212,P<0.001)。单纯组术后未出现肠穿孔及肠瘘患者;复合组术后肠穿孔及肠瘘发生率为10.5%(4/38),其中3例经抗结核、营养支持及换药引流治疗后瘘口愈合,1例再次行盲肠穿孔肠切除吻合术,术后出现感染性休克,家属放弃治疗出院。两组患者随访18~24个月,1例死亡(复合组),死亡率为1.3%(1/75),6例失访,68例经治疗后治愈,治愈率为98.6%(68/69)。结论:腹腔结核患者Ⅰ期手术治疗大部分可取得良好手术效果,腹腔结核累及腹腔脏器较多的患者术中出血量、手�Objective: To investigate the effect of stage Ⅰ operation on different types of abdominal tuberculosis. Methods: Clinical data of 75 abdominal tuberculosis patients treated with surgery in patients with tuberculosis from Shaanxi Tuberculosis Prevention and Control Hospital between January 1, 2016 and June 30, 2020 were collected. The diagnosis was confirmed by bacteriology or pathology. According to whether abdominal tuberculosis involves ≥2 abdominal organs, the patients were divided into pure group(n=37) and the composite group(n=38), the surgery conditions, postoperative complications, and the efficacy of surgery of the two groups were compared. Results: All the patients in the two groups were treated with stage Ⅰ operation, 11 intestinal tuberculosis patients from the simple group underwent excision of ileocecal part the end of the cecum and ascending colon end to end anastomosis, 23 tuberculous peritonitis patients underwent removal of abdominal tuberculous abscess lesions, 3 patients with abdominal lymph node tuberculosis underwent mesenteric lymph node tuberculosis and removal of retroperitoneal lymph node tuberculosis kitchen. In the composite group, 4 patients were treated with intestinal perforation underwent perforation repair+abdominal abscess removal+intestinal adhesion release, and 15 intestinal tuberculosis patients complicated with tuberculous peritonitis underwent ileocecal intestinal resection and anastomosis+abdominal abscess removal+intestinal adhesion release, 19 intestinal tuberculosis patients complicated with tuberculous peritonitis and abdominal lymph node tuberculosis were treated with intestinal resection and anastomosis+abdominal abscess removal+mesenteric and retroperitoneal lymph node removal+intestinal adhesion release. Intraoperative blood loss, and operation time and postoperative drainage volume in the composite group were significantly higher than those in the simple group((1271.84±66.28) ml vs.(594.32±35.92) ml, t=-8.986, P<0.001;210.0(145.0, 307.5) min vs. 80.0(60.0, 9

关 键 词：结核 腹腔 外科手术 对比研究 

分 类 号：R524[医药卫生—内科学]