艾滋病合并腹腔结核治疗经验分析

Analysis of the experience in the treatment of AIDS with abdominal tuberculosis

目的探讨艾滋病患者合并腹腔结核的治疗经验。方法回顾性分析70例艾滋病合并腹腔结核的治疗情况。结果其中肠穿孔16例（肠管多发穿孔4例，单处穿孔12例）；不完全性肠梗阻30例（单纯回盲部结核18例，结核性腹膜炎致广泛粘连性梗阻12例）；完全性梗阻24例（回盲部结核12例，粘连带绞窄肠管7例）。手术治愈61例，9例广泛粘连性肠梗阻经内科保守治疗后痊愈。结论不全性结核性肠梗阻，反复发作者，嘱患者仍需规律服用抗病毒药物，严格抗结核治疗3个月以上无效后即可施行手术。腹腔结核致完全梗阻（短期内治疗无效）、肠穿孔者，宜尽早手术，解决患者梗阻问题，使患者能尽可能早的服用抗HIV病毒药物，提高患者免疫力。亦有利于结核的治疗、减少其他伴发病感染机会，延长患者生命。围术期的抗HIV病毒治疗、营养支持，把握手术时机，选择合理的手术方式，强化规范的抗结核治疗，是治疗AIDS合并腹腔结核的关键。

Objective To investigate the treatment experience of AIDS patients with abdominal tuberculosis. Methods The treatment of 70 cases of AIDS complicated with abdominal tuberculosis were retrospectively analyzed. Results Among the 70 cases, there were 16 cases of bowel perforation （ inclu- ding 4 cases of multiple perforation, 12 cases of single perforation） ; 30 cases of incomplete intestinal ob- struction （18 cases of simple ileocecal tuberculosis, 12 cases of tuberculous peritonitis with extensive ad- hesion obstruction） ; 24 cases of completeness obstruction （including 12 cases of ileocecal tuberculosis, 7 cases of adhesive band strangulation of intestinal canal）. Sixty-one cases were cured by operation, and 9 cases of extensive adhesive intestinal obstruction recovered after conservative treatment. Conclusions For infully repeated tuberculous intestinal obstruction, the patient still needed regular use of antiviral drugs, strict anti tuberculosis treatment for more than 3 months after the ineffectiveness of the operation can be performed. Complete obstruction caused by abdominal tuberculosis （invalid short term therapy）, intestinal perforation, obstruction should be operated as soon as possible, solve the problem as soon as possible, so that patients can take HIV drugs, improve the immunity of patients, but also condu- cive to the treatment of tuberculosis, reduce the incidence of infection with other disease, and prolong the life of patients. Perioperative anti-HIV treatment, nutritional support, grasp the operation time, choosing the reasonable operation method, intensive and standardized anti-tuberculosis treatment, is the key to treat the AIDS merged abdominal tuberculosis.