【作者】 谢永平；

【导师】 陈卫星；

【作者基本信息】 浙江大学 ， 内科学， 2010， 硕士

【摘要】 目的：探讨肠结核的临床特点,了解如何提高肠结核的正确诊断率及肠结核的预后。方法：回顾性分析我院2005.12-2010.1收治的21例肠结核患者的临床资料并结合文献分析探讨。结果：21例患者中男性7例,女性14例；年龄在19-88岁之间,平均年龄47.8岁。文化程度以初中及以下(85.7%)的农民为主(42.8%)。常见症状为腹痛(66.7%),但疼痛位置不定,多以下腹痛为主；其次是消瘦(47.6%),表现为腹胀和腹泻的亦较多,但以肠外病变为首要表现的不多。体征以腹部压痛为主(66.7),也常触及浅表淋巴结肿大(28.6%)。实验室检查中多数患者血沉升高(80.9%),另外贫血(61.9%)、PPD实验阳性(57.0%)、CRP增高(57.0%)以及低蛋白血症和血CA125升高(各占47.6%)也有较高的提示意义。影像学上,胸片(64.7%)可用于筛查结核,CT扫描便于发现病变位置(86.7%),但是诊断特异性不高,多数提示病变肠段增厚(73.4%)或占位可能(13.3%)。大肠镜或胶囊内镜检查多提示病变肠段溃疡(73.3%),且病变多位于右半结肠或回肠。病理组织学检查见肉芽肿性炎(52.6%)或抗酸染色找到抗酸杆菌(36.8%)。治疗过程中1例患者因抗结核药物无法耐受而自行停药,其余病人中：治疗后57.1%的患者腹痛完全缓解,66.7%体重增加,85.7%腹胀消失,71.4%腹泻消失,能耐受治疗的所有患者体温均恢复正常。结论：肠结核是临床上较常见的疾病,但是诊断和鉴别诊断较困难,与克罗恩病鉴别尤其困难。诊断时要综合既往结核病史或结核病接触史、临床症状、体征、实验室检查以及肠镜或手术病理、影像学检查等资料,确诊主要依靠肠镜或手术病理。胸部正位片可用于筛查结核,腹部CT便于发现病变位置,但诊断特异性不强。除非有严重并发症,肠结核患者的预后一般均较好。更多还原

【Abstract】 Objective:To investigate the clinical features and prognosis of intestinal tuberculosis and learn how to improve the rate of correct diagnosis.Methods:The clinical data of 21 patients with intestinal tuberculosis were analyzed retrospectively and related literatures were discussed.Results:There were 7 cases of male,14 cases of female in total 21 cases; aged between 19 and 88 years old with an average age 47.8 years old. Most of the patients graduated from or under from Middle School (85.7%), and they are mainly farmers (42.8%). Common symptoms included abdominal pain (66.7%), weight loss (47.6%), abdominal distention, and diarrhea, little manifested as extra-intestinal lesions. The location of pain was uncertainty and most lies in inferior belly. The physical examination of intestinal tuberculosis was non-specific, most Signs in abdominal tenderness (66.7), and were often touched on superficial lymph nodes (28.6%). Most laboratory tests in such patients were abnormal, such as erythrocyte sedimentation rate elevated (80.9%), anemia (61.9%), PPD test positive(57.0%), CRP increased (57.0%) and hypoproteinemia(47.6%) and serum CA125 (47.6%) also elevated, which can tip intestinal tuberculosis. The chest X-ray (64.7%) can be used for screening of tuberculosis, CT scans easy to find location of lesions (86.7%), but its specificity is not high, most indicated thickened bowel wall (73.4%) or a lump (13.3%). Colonoscopy or capsule endoscopy indicated signify ulcer (73.3%), and the lesions were located at right colon or ileum. Granulomatous inflammation (52.6%) can be found in Histopathological or acid-fast bacilli were found (36.8%). After treatment,1 patient was removed because she could not tolerate the anti-TB drugs, in the other patients:57.1% of abdominal pain was complete remission,66.7%weight increase,85.7%of abdominal distension disappeared,71.4%of the diarrhea disappeared, the body temperature of all patients tolerated the treatment returned to normal in all patients.Conclusion:Intestinal TB is a common disease, but its diagnosis and differential diagnosis was rather difficult, and the identification between the two diseases is particularly difficult. When diagnosed of tuberculosis, we should make up of a comprehensive decision including the history of TB or TB exposure, clinical history, signs, and colonoscopy or surgical pathology, chest X-ray, CT scans etc., but when making a diagnosis, we mainly rely on colonoscopy or surgery pathology. So we can use chest X-ray for screening for tuberculosis; use abdominal CT for finding the location of lesion. Unless there are serious complications, the prognosis of patients with intestinal tuberculosis is generally good.更多还原