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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (3): 266-271.doi: 10.3969/j.issn.1000-6621.2019.03.005

• 论著 • 上一篇    下一篇

43例腹腔结核并发肠穿孔患者的外科治疗效果分析

徐慧海1,张珊珊1,2,李姿健1,齐海亮1,杜秀然1,苏宏伟1()   

  1. 1 050048石家庄,河北省胸科医院胸二科
    2 河北省肿瘤医院(东院)手术室
  • 收稿日期:2018-05-25 出版日期:2019-03-10 发布日期:2019-03-15
  • 通信作者: 苏宏伟 E-mail:13933825845@163.com

Surgical therapy in 43 abdominal tuberculosis patients complicated with intestinal perforation

Hui-hai XU1,Shan-shan ZHANG1,2,Zi-jian LI1,Hai-liang QI1,Xiu-ran DU1,Hong-wei SU1()   

  1. 1 The 2nd Department of Thoracic Surgery,Hebei Chest Hospital,Shijiazhuang 050048,China
  • Received:2018-05-25 Online:2019-03-10 Published:2019-03-15
  • Contact: Hong-wei SU E-mail:13933825845@163.com

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。

关键词: 结核, 胃肠, 肠穿孔, 外科手术, 治疗结果

Abstract:

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 anastomosis. One case underwent partial ileectomy and intestinal anastomosis due to a single perforation in the proximal ileocecal area, concurrent with abdominal lymph node tuberculosis and adhesion of local lymph node nodules and perforation site, but mild abdominal infection. No postoperative serious complications occurred in the patient. Anti-tuberculosis treatments were stopped after 12 months of treatment due to cure outcome. Thirty-seven patients were followed up for 18 to 24 months after treatment discontinuation, and 4 patients were lost to follow-up. During the follow-up period, 16 patients had intermittent mild abdominal pain, and others were generally in good condition. Conclusion Abdominal tuberculosis with intestinal perforation is a serious complication of tuberculous. On the basis of standard anti-tuberculosis drug treatments, surgery is the primary choice with good outcome.

Key words: Tuberculosis, gastrointestinal, Intestinal perforation, Surgical procedures, operative, Treatment outcome