结核性阑尾炎的诊断与治疗

Diagnosis and treatment of tuberculous appendicitis

目的探讨结核性阑尾炎的诊断和治疗方法。方法对１９６８～１９９７年收治的４６５２例阑尾炎中，经病理确诊的１２例（占０２６％）结核性阑尾炎作回顾性分析。结果本组病例的平均发病年龄为３５岁，女性多见，男女比为１∶２，多为继发（７例）。１２例中增殖型７例，溃疡型３例，混合型２例。术前均误诊，术中确诊２例。１２例均手术治疗，单纯阑尾切除７例，盲肠部分切除２例，右半结肠切除１例，合并回盲部淋巴结切除２例，术后抗结核治疗９例。１２例均顺利痊愈，无并发症。结论结核性阑尾炎发病率低，临床表现无特异性，术前确诊困难，要注意术中观察并重视病理检查。应早期手术和术后抗结核治疗，防止并发症产生。

Objective To study the diagnosis and treatment of tuberculous appendicitis. Method 12 cases (0.26%) with tuberculous appendicitis diagnosed by histopathological examination selected from 4 652 patients during 1968 to 1997 were analysed retrospectively. Result The mean age of the patients with tuberculous appendicitis was 35 years, the disease occurred 2 times more frequently in women than in men and was usually secondary to tuberculosis elsewhere in the body (7 cases). There were 7 cases with proliferative lesions, 3 cases with ulcerative lesions and 2 cases with two kinds of lesions. 12 cases were all misdiagnosed preoperatively, 2 cases were diagnosed definitely in the operation. In 12 cases, 7 cases underwent simple appendectomy, 2 cases partial celectomy and 1 case right hemicolectomy, appendectomy and resection of regional lymph nodes were performed on 2 cases, treatment of anti TB was given postoperatively to 9 patients. All the patients recovered without complications. Conclusion It′s hard to get definite diagnosis of tuberculous appendicitis before operation because of low incidence and non specific clinical manifestations, so careful observation in the operation and routine histopathological examination must be emphasized. Early operation and postoperative treatment of anti TB should be advocated in order to prevent from complications.