18例脾结核临床分析

Clinical Analysis on 16 Cases with Splenic Tuberculosis

目的探讨脾结核的诊断及治疗措施。方法对18例脾结核患者的临床资料进行回顾性分析。结果18例病人中表现为发热14例(占77.7%),腹痛9例(占50.0%),发热病程为1周至12个月,平均热程为2个月。其他较常见症状体征为腹胀4例(占22.2%)、盗汗4例(22.2%)、乏力5例(占27.8%)、纳差7例(38.9%)、贫血7例(38.9%)、脾肿大9例(占50%)。手术及病理诊断12例,1例胃液发现抗酸杆菌确诊,5例经试验性抗结核治疗有效确诊。18例病人中10例合并脾外结核。确诊前误诊9例(50%)。2例病人死亡,余16例均经手术及或1年以上的抗结核治疗,经随访预后良好。结论脾结核以长程发热和腹痛为突出表现,误诊率高,诊断主要依靠脾切除病理学检查及诊断性治疗,选择性手术治疗及系统性抗结核治疗是脾结核的主要有效治疗手段。

Objective To study clinical diagnosis and treatment of splenic tuberculosis. Methods The clinical data of 18 cases with splenic tuberculosis were retrospectively analyzed. Results Among 18 patients,fever was found in 14,abdominal pain in 9.The course of fever varied 1 week to 12 months and the mean course is about 2 months.Other common symptoms and signs had abdominal distension in 4,night sweat in 4,anergy in 5,anorexia in 7,splenomegaly in 9.Twelve cases of splenic tuberculosis were confirmed by surgery and pathologic diagnosis,1 case by founding of acid-fast bacillus in gastric juice,5 cases by diagnostic therapy.Of 18 patients,10 cases had extra-splenic tuberculosis.9 cases were misdiagnosed before confirmed diagnosis.Among the 18 cases,except 2 dead cases,the others received anti-tuberculosis chemotherapy for more than 1 year,and recovered well. Conclusion Splenic tuberculosis mainly presents with a long course of fever and abdominal pain,having high rate of misdiagnosis.The diagnosis of splenic tuberculosis mainly relies on pathology and diagnostic therapy,systemic antituberculous therapy and selectivity surgical treatment are the major therapenutic method.