关键词: 结核, 胃肠, 急腹症, 肠瘘, 外科手术, 结果与过程评价(卫生保健)

Abstract:

Objective To explore the diagnosis and surgical treatment experience of intestinal tuberculosis with severe complications.Methods Data of 176 surgical cases of intestinal tuberculosis with severe complications from the 309th Hospital between May 2006 and May 2016 were retrospectively reviewed, including the timing of surgery, the choice of operation, postoperative complications, prognosis and follow-up results. Among the patients, 132 (75.0%) were complicated with intestinal obstruction, 16 (9.1%) were acute intestinal perforation, 7 (4.0%) were chronic intestinal fistula, 6 (3.4%) were intestinal obstruction and intestinal perforation, 11 (6.3%) were intestinal obstruction and intestinal fistula, 4 (2.3%) were intestinal bleeding.Results Thirty-one cases (17.6%) underwent emergency operation, 96 complete intestinal obstruction cases (54.5%) underwent operation after conservative treatment for 48-72hours, 31 (17.6%) incomplete intestinal obstruction cases and 18 (10.2%) chronic intestinal fistula cases were operated because of poor anti-tuberculosis effect. The 132 cases complicated with intestinal obstruction underwent intestinal adhesion lysis and partial small bowel resection; of them, 4 gave up surgery because of extensive intraperitoneal adhesion, 11 underwent partial small bowel resection with small bowel stoma, and then underwent second-stage operation. The 40 cases complicated with intestinal obstruction plus acute perforation or chronic fistula underwent partial enteric resection, 17 cases complicated with intestinal obstruction also underwent enterodialysis in addition, and 12 cases underwent enterostomy. Partial enterostomy was performed in 4 cases with intestinal bleeding and enterostomy was performed at the same time. Of all the 176 cases, 20 cases (11.4%) had early operative complications, including intestinal fistula in 2 cases, intestinal bleeding in 1 case, abdominal or pelvic abscess in 3 cases, pulmonary infection in 4 cases, deep vein thrombosis in 2 cases, and wound infection in 8 cases; all of these cases were cured by conservative treatment such as anti-infection, anticoagulation and dressing change. Two cases died after operation, the mortality rate was 1.1% (2/176). And 166 patients were followed up for 12-18 months, with an average follow-up time of (15.8±4.2) months, while the other 8 were loss to follow-up. The follow-up rate was 95.4% (166/174). Three months after operation, the clinical symptoms of intestinal tuberculosis were completely relieved in 143 cases (86.1%, 143/166), second operations were performed in 8 cases (4.8%, 8/166) due to intestinal obstruction, intestinal perforation or intestinal fistula after operation. Abdominal pain, abdominal distention, diarrhea and constipation symptoms could not be alleviated in 15 cases (9.1%, 15/166) during the follow-up period.Conclusion The severe surgical complications of intestinal tuberculosis should be operated in time. Correct operative timing, reasonable choice of operation and standardized anti-tuberculosis treatment are the keys to successful treatment for severe complications of intestinal tuberculosis.

Key words: Tuberculosis, gastrointestinal, Acute abdomen, Intestinal fistula, Surgical operation, Outcome and process assessment (health care)