溃疡型肠结核穿孔手术方式探讨

Exploring the way of Ulcerative Intestinal Tuberculosis Perforation Surgical

肠结核可分为溃疡型、增殖型、纤维硬化型及溃疡增生型[1],可累及肠道任何部位,以回盲部最多见。肠穿孔主要并发于溃疡型肠结核,此型病变活跃,当溃疡浸及粘膜下层后,可进而浸蚀肌层及浆膜层而穿孔。溃疡型肠结核穿孔病情凶险,不仅术前诊断困难,因病人往往长期腹痛,肠穿孔引起的腹膜炎表现易被忽略,且手术中溃疡性病变较为广泛,手术困难。现收集10例溃疡型肠结核穿孔病例对其手术方式作一探讨。①对于溃疡型肠结核较为局限,我们采取病变肠段切除的手术方式;②对于溃疡型肠结核病变范围较为广泛,我们采取切除病变较为严重肠管,对于病变较为分散的肠管,我们没有采取分段切除,而采取纵切横缝肠管整形的方法予以处理,尽可能保留肠管;③对于肠结核穿孔,我们不推荐行肠修补术,而建议采取纵切横缝肠管整形的方法或病变肠管切除的方法。④对于慢性穿孔引起的腹腔脓肿,建议行切开引流术后,二期再行病变肠管切除术;⑤慢性穿孔引起的肠瘘,先行腹壁瘘口清创引流,二期再行病变肠管切除术。

Intestinal tuberculosis can be divided into the ulcer type, proliferation, fiber sclerosis and ulcers hyperplasia . Intestinal tuberculosis can affect any part of the intestinal,ileocecal most common.Intestinal perforation complicated by ulcerative intestinal tuberculosis,active lesions of this type.Mter ulcer dip and the submucosa,thus etching muscularis and serosa perforation. Ulcerative intestinal tuberculosis perforation dangerous disease,not only preoperative diagnosis is difficult, because the patients are often long-term abdominal pain. Peritonitis caused by intestinal perforation is often overlooked and surgery of ulcerative lesions more extensive surgery is difficult. Now collected 10 cases of ulcerative intestinal tuberculosis perforation cases explore their surgery. ① For ulcerative intestinal tuberculosis is more limited, we have taken the lesions bowel resection surgery; ②For ulcerative intestinal tuberculosis becomes wider range, we take the removal of lesions more serious intestinal.For more scattered lesions intestine, we did not take the step cut taken longitudinal contraction joints bowel shaping methods to be dealt with, as far as possible to retain the intestine;③For the perforation of the intestinal tuberculosis,we do not recommend line intestinal repair recommendations longitudinal contraction joints bowel shaping or diseased bowel resection; ④For chronic perforation caused by intra-abdominal abscess, it is recommended that after incision and drainage lines two further lesions bowel resection; ⑤The chronic perforation caused the intestinal fistula in advance of the abdominal wall debridement and drainage fistula, two further lesions bowel resection.