15例肠结核临床诊疗分析

发布时间：2018-07-08 10:29

本文选题：肠结核 + 诊断　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：通过15例临床肠结核的临床表现、实验室检查的结果并复习文献对该类患者的误诊原因进行分析，以提高医师对该类疾病的早期认知、识别，准确诊断，及时治疗的能力，从而减少误诊。方法：回顾性分析我院2008年3月至2013年10月共15例肠结核患者，因表现缺乏特异性被误诊，后经肠镜活检或手术病理最终确诊。结果：本组肠结核患者15例，男6例，女9例，年龄14-64岁不等，平均年龄32.5岁；病程2个月-4年。误诊为克罗恩病5例、腹腔恶性肿瘤2例、急性肠穿孔并发腹膜炎1例、肠梗阻2例、盆腔炎1例、肠淋巴瘤1例，急性阑尾炎2例、贫血1例。10例初次结肠镜检查患者9例发现病灶，最终取活检确诊，余1例二次肠镜取活检确诊，5例通过腹部手术病理确诊。常见的临床表现腹痛、发热、结核中毒症状、腹泻与便秘。最常见的并发症为肠梗阻。肠结核好发部位为回盲部。所有患者均确诊后转入结核病院抗结核治疗6-20个月不等，平均10.3个月，均获随访，全部治愈，无因肠结核死亡病例。结论：肠结核临床表现无特异性加上病例少见，误诊率高，本组15例肠结核患者均为误诊病例。本病高发于青壮年，女性多于男性，，病变部位按好发率依次为回盲部、升结肠、回肠末端，横降结肠。本组合并肺结核患者3例占20%。结肠镜取活组织检查及手术探查取病理为肠结核确诊的重要手段，辅助检查血常规、血沉、X线造影等检查可提高肠结核确诊率。
[Abstract]:Objective: to analyze the clinical manifestations of 15 cases of clinical intestinal tuberculosis, the results of laboratory examination and review the literature to analyze the causes of misdiagnosis in order to improve the physician's early cognition, recognition, accurate diagnosis, and timely treatment, so as to reduce the misdiagnosis.
Methods: a retrospective analysis of 15 cases of intestinal tuberculosis from March 2008 to October 2013 was made in our hospital. The patients were diagnosed by enteroscopy or surgical pathology because of the lack of specificity and misdiagnosis.
Results: 15 cases of intestinal tuberculosis, 6 male and 9 female, age 14-64 years old, average age 32.5 years, 2 months -4 years, 5 cases of Crohn's disease, 2 cases of abdominal malignant tumor, 1 cases of acute intestinal perforation complicated with peritonitis, 2 cases of intestinal obstruction, 1 cases of pelvic inflammation, 1 cases of intestinal lymphoma, 2 cases of acute appendicitis, and primary colonic colonoscopy in.10 cases of anemia. 9 cases were found, final biopsy was confirmed, 1 cases were diagnosed by two bowel biopsy, 5 cases were diagnosed by abdominal surgery. Common clinical manifestations of abdominal pain, fever, tuberculosis poisoning, diarrhea and constipation. The most common complication was intestinal obstruction. The good location of intestinal tuberculosis was ileocecal. All patients were transferred to tuberculosis hospital after diagnosis. Anti tuberculosis treatment ranged from 6-20 months to 10.3 months. All patients were followed up. All cases were cured without death due to intestinal tuberculosis.
Conclusion: the clinical manifestations of intestinal tuberculosis were unspecific, and the misdiagnosis rate was high. 15 cases of intestinal tuberculosis were misdiagnosed in this group. This disease occurred in young and Zhuang years, women more than men. The lesion site was in turn, ascending colon, distal ileococine, and 3 cases of 20%. colonoscopy group. Examination and surgical exploration are important means for diagnosis of intestinal tuberculosis. Auxiliary examination of blood routine, erythrocyte sedimentation rate and X-ray examination can improve the diagnosis rate of intestinal tuberculosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R524

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