结核性腹膜炎临床特点研究

Research of clinical characteristics of tuberculous peritonitis

目的分析结核性腹膜炎(TBP)临床特征,提高TBP诊断率,为临床工作提供参考。方法回顾性分析2010年8月-2018年6月天津市海河医院收治的21例TBP患者临床资料,对其临床特点、腹部影像表现及实验室结果进行分析。结果 TBP常见临床症状主要以发热、腹痛、腹胀、腹部柔韧感和体重减轻为主。多数患者伴有其他脏器结核,占61.9%。T-SPOT阳性率高于PPD试验和TB-Ab阳性率,差异均有统计学意义(P<0.05)。腹部CT发现有81.0%患者发生网膜及腹膜增厚,亦可发现腹部淋巴结肿大、肠系膜增厚等。21例TBP患者均经腹膜活检病理确诊为干酪样肉芽肿伴凝固性坏死,其中12例患者行腹腔镜检查,术后伤口愈合良好、无并发症,9例行开腹探查中3例出现窦道,伤口不易愈合,预后差。结论 TBP患者多伴有其他脏器结核,临床症状不典型,腹部CT以网膜及腹膜增厚为主,应对疑似TBP患者进行腹腔镜检查,获得组织病理结果,从而有效减少并发症的发生。

Objective To analyze the clinical characteristics of tuberculous peritonitis(TBP) and improve the diagnostic rate of TBP,provide reference for clinical work.Methods The clinical data of 21 patients with TBP admitted to Tianjin Haihe Hospital from August 2010 to June 2018 were retrospectively analyzed.The clinical characteristics,abdominal imaging manifestations and laboratory results of the patients were analyzed.Results The main clinical symptoms of TBP were fever,abdominal pain,abdominal distension,abdominal flexibility and weight loss.Most patients were accompanied by tuberculous of other organs,accounting for 61.9%.The positive rate of T-SPOT was higher than that of PPD test and TB-Ab,and the differences were statistically significant(P<0.05).Abdominal CT found that 81.0% of patients with omentum and peritoneal thickening,and abdominal lymph node enlargement and mesentery thickening were also found.Twenty one patients with TBP were diagnosed as caseous granuloma with coagulative necrosis by peritoneal biopsy pathology,12 patients of them underwent laparoscopic examination,and the wound healed well without complications after operation.Among 9 patients undergoing laparotomy exploration,sinus tract appeard in 3 cases,the wound was not easy to heal,and the prognosis was poor.Conclusion TBP patients were mostly accompanied by other organs tuberculous,with atypical clinical symptoms.Abdominal CT mainly focused on omentum and peritoneum thickening.It should choose laparoscopy for patients suspected TBP to obtain histopathology results,so as to effectively reduce complications.