回盲部结核74例的诊断与外科治疗

Diagnosis and surgical treatment of tuberculosis in ileocecal junction in 74 cases

目的:总结回盲部结核的诊断与外科治疗经验。方法:回顾性分析我院手术治疗回盲部结核74例的临床资料。结果:钡剂灌肠透视确诊率63.8%(30/47);纤维结肠镜检+活组织检查确诊率为100%(74/74)。回盲部结核术前确诊率低为68.9%(51/74)。术前非静止期结核给予抗结核药物治疗。53例行右半结肠切除术(彻底切除病变肠段);15例行回肠末段与横结肠吻合的捷径手术;6例行回肠末段造瘘术。68例切口一期愈合,6例切口感染,经1～3周换药痊愈。结论:回盲部结核需应尽早明确诊断,与回盲部癌相鉴别;积极的手术治疗,配合系统的药物治疗,预后良好。

Objective： To summarize experience of diagnosis and surgical treatment of tuberculosis in ileocecal junction. Methods： Clinical data of 74 cases of tuberculosis in ileocecal junction were analysed retrospectively, Results： Clinical manifestations consisted of chronic abdominal pain （87.8% ）, right lower abdominal mass （95.9% ）,low fever、emaciation and anemia （36.5%）, alternation of constipation and diarrhea（39.2%）.Diagnosis rate of barium enema was 63.8%, colonoscopy and biopsy was 100%. Diagnosis rate before operation was 68.9% （51/74）. In 74 cases, 53 cases performed right hemicolectomy, 15 cases performed anastomosis of end of ileum and transverse colon, 6 cases performed building fistula of end of ileum. Conclusion： Tuberculosis in ileocecal junction should be diagnosed early and be identified with cancer of ileoceum. Good prognosis depend on positive surgical treatment and systematic medicine treatment.