大肠结核的现代诊断与治疗

The Diagnosis and Treatment of Large Intestine Tuberculosis

大肠结核较为少见，临床误诊率高，文章旨在提高诊断正确率及进行合理的治疗。通过对２３例大肠结核病人的诊治过程进行的回顾性分析，发现大肠结核的术前、术后误诊率分别为７８．３％和４５．０％，较易误诊的疾病是恶性肿瘤与克隆病。其中１８例得到随访，平均随访时间９．７年，均被治愈而无复发。认为ＰＣＲ技术检测结核杆菌、内镜细针抽吸细胞学检查将能提高大肠结核的诊断率；全消化道造影有助于与大肠肿瘤的鉴别；与克隆病的鉴别主要依赖于病理学检查及诊断性抗痨治疗；必要时可行剖腹探查术，但术中应常规行快速切片检查。提示：若能术前明确诊断，多数病人能经抗痨治愈，则可避免不必要的手术探查。

Large intestine tuberculosis (LIT) is rare and has a high misdiagnosis rate. The aim of this study is to improve the diagnosis and treatment. Twentythree cases of LIT were retrospectively analysed in this paper. We have found out that pre and intraoperative misdiagnosis rates were 78.3% and 45.0% respectively. LIT was most commonly confused with malignant tumors and Crohn's disease. 18 cases of all have been followed up for a mean time of 9.7 years, none have relapsed. The detection of polymerase chain reaction (PCR) and endoscopic fine needle aspiration cytology may contribute to the differential diagnosis of LIT. Gastrointestinal series is helpful to differentiate tumors from LIT, and the identification between LIT and Crohn's disease mainly depends on histology and diagnostic antituberculosis therapy. Exploratory laparotomy should be performed if necessary and intraoperative rapid biopsy should be done routinely. The paper also shows that if right diagnosis is established most patients can be cured with antituberculosis therapy and avoided unnecessary exploratory laparotomy.