提高对回盲部结核的认识、诊断及外科治疗

Improving the awareness,diagnosis,and surgical treatment of ileocecal tuberculosis

回盲部结核是指结核杆菌侵犯肠道引起的慢性特异性感染。肠结核多发于回盲部。根据病期早晚不同,可分类为溃疡型肠结核:早期多合并活动期肺结核,不适于外科手术治疗;增生型肠结核:起病慢,病程长达8年,无活动性肺结核。右下腹可触及较硬韧、固定的腹部肿块,钡剂灌肠大肠造影显示回盲部变短、挛缩、狭窄、回盲瓣变形或行纤维结肠镜检可见肿块、溃疡环状狭窄,取活检可以确诊。手术治疗应根据病情而定,原则上应彻底切除病变肠段,再行肠道重建术。充分的术前准备是手术成功的关键措施之一。

The ileocecal tuberculosis refers to chronic specific intestinal infection by mycobacterium tuberculosis. Intestinal tuberculosis mainly occurs in the ileocecal. According to different stages of disease,it can be classified as ulcerative intestinal tuberculosis,which is not suitable for surgical treatment,and consolidated active tuberculosis in early. The other is hyperplastic intestinal tuberculosis,it is slow onset,and duration is up to eight years,without active tuberculosis. The harder fixed abdominal mass can be touched in right lower abdomen,it can be showed ileocecal shorter,contracture,narrow,ileocecal valve distortion by barium enema colon angiography,or it can be found lumps,ulcers ring narrow by fiberoptic colonoscopy,and can be diagnosed by biopsy. Surgical treatment should be determined by the severity of disease,and should thoroughly remove lesion bowel in principle,and then reconstruct intestine. Adequate preoperative preparation is one of the key measures of successful operation.