结核性肛瘘的临床治疗探讨

发布时间：2018-01-26 15:58

本文关键词： 肛瘘结核性肛瘘肺结核肛周脓肿结直肠外科手术　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨抗结核治疗和手术治疗肺结核患者伴发结核性肛瘘的时机选择及临床疗效分析。方法回顾性分析2008年1月-2016年1月新疆医科大学第一附属医院和新疆维吾尔自治区胸科医院肺结核患者伴发结核性肛瘘52例的临床资料,根据抗结核治疗前后手术时机的选择分为先手术后抗结核治疗组(A组)26例和先抗结核治疗后手术组(B组)26例,进行临床相关指标的对比分析。结果两组患者在性别(x2=0.087、P=0.768)、年龄(t=0.231、P=0.389)、民族(x2=0.391、P=0.532)、病程(t=0.422、P=0.672)、随访时间(t=0.377、P=0.708)上差异均无统计学意义(P0.05)。52例患者经肛门专科检查检出率为75%,联合高频彩超检查检出率为86.5%,对其中7例未检出者行MRI检查,检出率为100%。B组肛瘘治疗总体有效率为100.00%,明显高于A组的76.92%(Zc=2.023,P=0.043)。B组术后相关指标如术后疼痛评分(t=3.578、P=0.001)、术后疼痛时间(t=14.201、P=0.000)、术后愈合时间(t=3.782、P=0.000)及复发率(x2=4.127、P=0.042)差异有统计学意义(P0.05),明显优于A组;但在肛门括约肌功能(t=1.694、P=0.097)及生活质量评分(t=1.870、P=0.067)上差异无统计学意义(P0.05)。结论肺结核患者伴发结核性肛瘘时,应在确诊为肛瘘的基础上以病理检查或分泌物涂片和培养结果为金标准,抗结核治疗前后的手术时机选择与患者预后有一定关系,先抗结核治疗后手术治疗可能对患者的预后有帮助。
[Abstract]:Objective to explore the timing and clinical efficacy of anti-tuberculosis treatment and surgical treatment for pulmonary tuberculosis patients with tuberculous anal fistula. Methods the first report of Xinjiang Medical University from January 2008 to January 2016 was retrospectively analyzed. Clinical data of 52 cases of pulmonary tuberculosis associated with tuberculous anal fistula in Xinjiang Uygur Autonomous region chest Hospital and affiliated Hospital of Xinjiang Uygur Autonomous region. According to the choice of operation time before and after anti-tuberculosis treatment, the patients were divided into two groups: group A (n = 26) and group B (n = 26). Results the patients in the two groups were divided into two groups: the age was 0.231 and the age was 0.231). The duration of the disease was 0.422 ~ (0.22) ~ 0.67 ~ (2) and the follow-up time was 0.377. There was no significant difference between P0. 708 and P0. 05%. The detection rate of P0. 05 was 75 and that of high frequency color ultrasound was 86.5%. The total effective rate of anal fistula treatment in group B was 100.000.The total effective rate was significantly higher than that in group A (76.92%). In group B, the postoperative pain score was 3.578P0. 001g, and the time of postoperative pain was 14. 201 P0. 000 (P < 0. 000). There were significant differences in postoperative healing time (P < 3.782) and recurrence rate (P < 0.05) and recurrence rate (P = 0.042), which was significantly better than that in group A (P < 0.05). However, the anal sphincter function was 1.694P 0.097) and the quality of life score was 1.870. Conclusion Pulmonary tuberculosis patients with tuberculous anal fistula. On the basis of diagnosis of anal fistula, pathological examination or secretion smear and culture result should be taken as the gold standard. The choice of surgical timing before and after anti-tuberculosis treatment is related to the prognosis of the patients. First anti-tuberculosis treatment and then surgical treatment may be helpful to the prognosis of patients.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.16

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