胃结核75例临床分析

Clinical review of 75 cases with gastric tuberculosis

目的 提高胃结核的诊断及治疗水平。方法 回顾性总结松花江流域10所医院40年经手术及病理证实的75例胃结核的临床资料。结果 X线钡剂造影和纤维胃镜检查并取活检为主要确诊手段。75例患者手术治疗72例,占同期胃切除患者的0.37％。本组胃结核病例溃疡型占50.7％;结核病灶与癌或溃疡灶并存型仅占5.3％。手术治疗的72例中,68例痊愈(94.4％);术后均继续抗结核治疗6～12个月,58.8％的患者随访1～13年均健康。术后早期死亡4例,分别为溃疡型2例死于出血性休克和并存型2例死于晚期癌症。非手术治疗的3例因幽门梗阻、慢性衰竭而先后在确诊后3个月内死亡。结论 临床上胃结核以溃疡型多见;手术治疗是最有效的方法。

Objective To improve the diagnosis and treatment of gastric tuberculosis. Methods Clinical data of 75 cases with gastric tuberculosis confirmed by operation and pathology in ten hospitals of Songhua River drainage area within 40 years were analyzed retrospectively. Results The patients suffering from gastric tuberculosis made up 0. 37% of total patients receiving gastrectomy in the same period. Barium radiography of upper gastrointestinal tract, gastric fiberscopy and biopsy were the main diagnostic methods. The proportion of ulcerative type was 50. 7% , and tuberculosis co-existent with ulcer or carcinoma was 5.3%. Seventy-two patients received operation. Sixty-eight patients were cured with anti-tuberculosis therapy for 6 - 12 months and 4 patients died early postoperatively including 2 cases with bleeding shock and 2 cases with coexistent carcinoma. The cure ratio was 94. 4% . The 3 cases with non-surgical treatment died of pyloric obstruction and chronic weakness during 3 months after diagnosis. Conclusions Ulcerative type is most common in gastric tuberculosis. The patients with mild symptoms or no complications should be treated with anti-tuberculosis therapy, while the patients with complication should be treated with operation.