大肠结核的外科治疗

Surgical management of tuberculosis of large bowel

目的:探讨大肠结核的临床特征、诊断及外科治疗方法。方法:回顾性分析22例大肠结核患者的临床资料。结果:全组女性患者占多数,年龄19～76(44.5±10.5)岁,术前误诊率72.7%(16/22)。腹痛、腹部肿块和大便习惯改变为最常见的临床表现。全消化道造影、结肠镜及腹腔镜病理活检有利于大肠结核的诊断,确诊主要依赖于病理学检查。22例患者因误诊或并发症分别行病变肠段局部切除、回盲部或右半结肠切除、肠粘连松解、脓肿清除及探查性手术,术后联合抗结核治疗6～24(8.2±5.3)个月。所有患者术后随访6～120(55.8±15.5)个月,治愈19例,3例症状缓解。结论:大肠结核误诊率高,手术多因误诊或并发症而进行,选择合适的手术时机及正确的手术方法非常重要。

Objective： To summarize the clinical characteristics, diagnosis and surgical treatment of tuberculosis of large bowel. Methods： The clinical data of 22 patients with tuberculosis of the large bowel admitted to our hospital were retrospectively analyzed. Results： Female patients accounted for the majority of the whole group. The ages of the patients were from 19 to 76 （average of 44.5±10.5） years and the misdiagnosis rate before surgery was 72.7% （16/22）. The main clinical manifestations of the patients were abdominal pain, abdominal mass, and stool-habit alteration. The gastrointestinal contrast examinations, and colonoscopic and laparoscopic biopsies were helpful for the detection of this disease, and the definite diagnosis mainly depended on the pathological finding. Due to misdiagnosis or complications, 22 patients underwent resection of the affected bowel segment, ileocecal resection or right hemicolectomy, adhesiolysis, abscess evacuation and exploratory operation respectively, and the patients were treated with postoperative combined anti-tuberculosis treatment for 6 to 24 （average of 8.2±5.3） months. All patients were followed up for 6-120 （55.8±15.5） months, of whom 19 were cured and 3 had symptomatic improvement. Conclusion： Tuberculosis of the large bowel has a high rate of misdiagnosis, so the surgical interventions are performed usually because of misdiagnoses or for complications.The selection of the surgical timing and procedure is important for these patients.