结核性腹膜炎多学科诊疗专家共识

doi:10.19982/j.issn.1000-6621.20250025

摘要/Abstract

摘要：

结核性腹膜炎临床表现不具有特异性,鉴别诊断困难,确诊时间往往滞后,使治疗难度加大。在诊疗过程中,通常会涉及多个专业和科室,需要多学科诊疗团队共同参与。结核性腹膜炎的及时诊断和治疗对患者的转归至关重要,然而,我国在该疾病的多学科诊疗方面尚缺乏相关指导性共识或指南。因此,为使结核性腹膜炎患者得到合理规范的系统性诊疗,改善患者预后,降低病亡率,中国人民解放军总医院第八医学中心结核病医学部、《中国防痨杂志》编辑委员会和中国医疗保健国际交流促进会结核病防治分会基础和临床学部联合组织多学科专家,结合我国目前结核性腹膜炎诊疗的经验与研究成果,共同制定《结核性腹膜炎多学科诊疗专家共识》。本共识概述了结核性腹膜炎的流行病学特征、病理生理机制和主要的临床表现,介绍了结核性腹膜炎的常见检查方法,提出了结核性腹膜炎的诊断标准和治疗建议,尤其对手术治疗患者的适应证、禁忌证、术前准备、手术方式和时机选择,以及术后患者处理等给出了推荐意见,旨在为临床医师提供科学、实用的参考依据。

关键词: 腹膜炎, 结核性, 学科间信息交流, 诊断, 治疗学, 总结性报告(主题)

Abstract:

Tuberculous peritonitis lacks specific clinical manifestations, making differential diagnosis difficult, and often leading to delayed confirmation of diagnosis, which increases the difficulty of treatment. In the process of diagnosis and treatment, multiple specialties and departments are usually involved, requiring the involvement of multidisciplinary teams (MDTs). Timely diagnosis and treatment are crucial for the prognosis of patients with tuberculous peritonitis. However, there is still a lack of relevant guiding consensus or guidelines for the multidisciplinary diagnosis and treatment of tuberculous peritonitis in China. Therefore, in order to provide reasonable and standardized systematic diagnosis and treatment for patients with tuberculous peritonitis, improve patient prognosis, and reduce mortality, Senior Department of Tuberculosis, the Eighth Medical Center of the Chinese People’s Liberation Army General Hospital, the Editorial Board of Chinese Journal of Antituberculosis, and Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange and Promotive Association for Medical and Health Care jointly organized multidisciplinary experts to formulate the Expert consensus on multidisciplinary diagnosis and treatment of tuberculous peritonitis, based on China’s current diagnostic and therapeutic experience and research achievements in tuberculous peritonitis. This consensus summarizes the epidemiological characteristics, pathophysiological mechanisms, and main clinical manifestations of tuberculous peritonitis, introduces common examination methods for tuberculous peritonitis, proposes the diagnostic criteria and treatments suggestions of tuberculous peritonitis, and especially gives recommendations on the indications, contraindications, preoperative preparation, surgical method and timing selection, and postoperative patient management, etc. It aims to provide clinical physicians with scientific and practical reference.

Key words: Peritonitis, tuberculous, Interdisciplinary communication, Diagnosis, Therapeutics, Consensus development conferences as topic

中图分类号:

中国人民解放军总医院第八医学中心结核病医学部, 《中国防痨杂志》编辑委员会, 中国医疗保健国际交流促进会, 结核病防治分会基础和临床学部. 结核性腹膜炎多学科诊疗专家共识[J]. 中国防痨杂志, 2025, 47(3): 243-257. doi: 10.19982/j.issn.1000-6621.20250025

Senior Department of Tuberculosis, the 8th Medical Center of Chinese PLA General Hospital , Editorial Board of Chinese Journal of Antituberculosis , Basic and Clinical Speciality Committees of Tuberculosis Control Branch of China International Exchange , Promotive Association for Medical and Health Care . Expert consensus on multidisciplinary diagnosis and treatment of tuberculous peritonitis[J]. Chinese Journal of Antituberculosis, 2025, 47(3): 243-257. doi: 10.19982/j.issn.1000-6621.20250025

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证据级别	具体描述	研究类型	表达字母
高级证据	非常确信真实的效应值接近效应估计,未来研究几乎不可能改变现有评价结果的可信度	随机对照试验;质量升高二级的观察性研究	A
中级证据	对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在二者大小相同的可能性;未来研究可能对现有评估有重要影响,可能改变评价结果的可信度	质量降低一级的随机对照试验;质量升高一级的观察性研究	B
低级证据	对效应估计值的确信程度有限:真实值可能与估计值大不相同;未来研究很有可能对现有评估有重要影响,改变评估结果可信度的可能性较大	质量降低二级的随机对照试验;观察性研究	C
极低级证据	对效应估计值几乎没有信心:真实值很可能与估计值大不相同;任何评估都很不确定	质量降低三级的随机对照试验;质量降低一级的观察性研究;系列病例观察;个案报道	D

证据质量	推荐强度	具体描述	表达数字
高级证据	支持使用某项干预措施的强推荐	评价者确信干预措施利大于弊	1
中级证据	支持使用某项干预措施的弱推荐	利弊不确定或无论高低质量的证据均显示利弊相当	2
低级证据	反对使用某项干预措施的弱推荐	利弊不确定或无论高低质量的证据均显示利弊相当	2
极低级证据	反对使用某项干预措施的强推荐	评价者确信干预措施弊大于利	1