结核性肠梗阻的外科治疗

Surgical treatment of tuberculous intestinal obstruction

目的 探讨结核性肠梗阻的诊断、手术治疗的时机及术式选择.方法 回顾性分析1996年6月至2015年2月手术治疗的368例结核性肠梗阻的病人资料.结果 梗阻症状有不同程度缓解359例,其中完全缓解212例,部分缓解147例;9例无效,其中死亡1例,死亡原因为全身器官功能衰竭;术后短期内炎性肠梗阻15例,经抗炎、持续胃肠减压、维持水电解质平衡、营养支持等治疗后均好转;肠瘘9例,给予局部充分引流,持续胃肠减压及全身营养支持治疗1～3个月后,自行愈合6例,另外行肠切除肠吻合手术治愈3例.切口裂开7例,经抗感染、换药治疗后愈合;腹壁窦道形成5例,门诊换药逐渐愈合.结论 围手术期的营养支持,把握合适的手术时机,选择合理的手术方式,规范的抗结核治疗,是治疗结核性肠梗阻的有效措施.

Objective To investigate the diagnosis, surgical treatment and timing of tuberculous intestinal obstruction. Methods The clinical data of 368 cases of tuberculous with intestinal obstruc- tion treated surgically from June 1996 to February 2015 were retrospectively analyzed. Results The obstruction symptoms relieved in 359 cases, including 212 cases of complete remission and 147 cases of partial remission. Nine cases were invalid, and there was one death due to multiple organ failure. The obstruction symptoms in 15 cases of short-term postoperative inflammatory bowel obstruction relieved by anti-inflammatory treatment, continuous gastrointestinal decompression, maintaining water and e- lectrolyte balance, and nutritional support. In 9 cases of intestinal fistula, after local administration of adequate drainage, continuous gastrointestinal decompression, and nutritional support for 1-3 months, 6 cases were cured; The rest 3 cases subject to intestinal anastomosis operation were cured. Incision dehiscence in 7 cases was cured after antiqnfection and dressing change. Sinus tract formation of ab- dominal wall in 5 cases was cured by outpatient dressing change. Conclusions According to our expe- rience and analysis, perioerative nutritional support, grasping the opportunity of operation, choice of reasonable surgical procedures, and standardized anti-tuberculosis treatment are effective measures for treating tuberculous intestinal obstruction.