27例结核性腹膜炎临床诊治分析

Clinical diagnosis and treatment analysis of 27 cases of tuberculous peritonitis

目的通过对27例结核性腹膜炎临床特点、诊治进行分析,以提高对结核性腹膜炎诊断水平。方法回顾性分析2003年5月—2012年4月27例结核性腹膜炎患者临床资料。结果腹痛、腹胀、腹水、发热、乏力是结核性腹膜炎的主要临床特征,辅助检查腹水为渗出液,PPD多呈强阳性,血沉、C反应蛋白及CA125明显升高,27例中有18例行实验性抗痨治疗有效,结合随访确诊,一例行腹腔镜检查结合病理确诊,有5例因合并肺结核通过正规抗痨治疗随访确诊,3例手术病理确诊,其中1例误诊急性阑尾炎并伴有肺结核,另2例为青少年患者因盆腔占位行手术治疗病理确诊。结论结核性腹膜炎诊断主要通过临床特点、辅助检查及实验性抗痨治疗有效而确诊,少数患者通过组织病理检查确诊,临床医师应提高对本病的认识,完善辅助检查减少误诊。

Objective：To improve diagonosis level of Tuberculous Peritonitis through analysis of clinical characteristics and diagnosis or treatment of Tuberculous Peritonitis. Methods clinical characteristics of 27 cases of tuberculous peritonitis diagnosed in The Mfiliated Lu＇an People＇s Hospital of Anhui Medical University from May. 2003 to Apr. 2012 were analyzed retrospectively. Results The main clinical features of tuberculous peritonitis included abdominal pain and distention, ascites ,fever, fatigue, in auxiliary＂ examinations, charac- teristics of aseites is exudates transudates; PPD is positive serviously; blood sedimentation rate （ ESR）, C-reaction protein （ CRP ） and CA125 levels elevated. 18 cases of total 27 cases received experimental antitubereulosis therapy efficaciously, and these cases followed up were cured successfully. 1 case diagnosed fllrough laparoscopy and pathology. 5 cases with tuberculosis of total 27 cases received antitu- berculosis therapy,and these cases followed up were cured. 3 cases of total 27 cases were diagnosed through postoperation pathology. 1 case was misdiagnosed as acute appendicitis and has tuberculosis ;2 teenagers cases received operation because of pelvic mass. Conclu- sions diagnosis of tuberculous peritonitis mainly should be made on clinical characteristics, attxiliary examinations and the efficacy of experimental antituberculosis therapy, a few cases of tuberculous peritonitis were diagnosed through pathology. Clinical doctor sbould im- prove knowin of tuberculous peritonitis, decreasin~ misdiaznosis through full of auxiliary examinations.