85例结核性腹膜炎的临床表现及随访分析

Clinical manifestations and following-up analysis of 85 cases of tuberculous peritonitis

目的回顾性分析结核性腹膜炎(tuberculous peritonitis,TBP)患者的临床表现及诊断方法,为提高临床对TBP的正确诊断率提供可借鉴的经验。方法收集2012年1月至2016年10月重庆医科大学附属第一医院85例资料完整、临床疑诊为TBP并行诊断性抗结核治疗的患者,随访抗结核治疗结果 3～12个月,并对其临床资料进行回顾性分析。结果本组疑诊TBP患者诊断符合率为77. 6%。其中腹腔镜及病理学检查阳性率最高(100%),腹部CT检查次之(93. 8%)。对于年龄<40岁患者,腹部CT检查对TBP的诊断符合率高达100%,但随年龄增加,诊断符合率逐渐下降。结论 TBP临床表现不典型,诊断较困难,实验室检查的灵敏度及特异度差。腹腔镜及病理学检查是诊断TBP的金标准,但临床实施和组织标本获取较困难。因此,腹部CT检查结合患者年龄并采用排除诊断法,是诊断TBP的关键。

Objective To analyze retrospectively the characteristics of tuberculous peritonitis （TBP）, and provide references for the diagnosis of TBP.Methods Eighty-five patients with TBP diagnosed in the First Affiliated Hospital of Chongqing Medical University from Jan. 2012 to Oct. 2016 were followed-up for anti-tuberculosis treatment （3-12 months） and their clinical features were analyzed retrospectively.Results Diagnostic coincidence rate of these patients was 77.6%. The positive rate of laparoscopy and pathology was the highest （100%）, followed by abdominal CT scan （93.8%）. For patients younger than 40 years old, diagnostic coincidence rate of abdominal CT examination was up to 100%, but the diagnostic rate was gradually decreased with the age increased.Conclusion The clinical manifestations of TBP are not specific, it is difficult to diagnosis. The sensitivity and specificity of laboratory test are poor. Laparoscopy and pathology are the gold standards for the diagnosis of TBP, but clinical implementation is difficult. Therefore, abdominal CT combined with the age of patients, excluded diagnostic method, is the key to the diagnosis of TBP.