肠结核合并肝结核、结核性胸腹膜炎一例并文献复习

发布时间：2018-12-11 23:12

【摘要】：目的：探讨肠结核、肝结核的发病原因、临床特征、影像学检查、鉴别诊断等,提高肠结核和肝结核的诊断和治疗水平。方法：分析1例肠结核合并肝结核、结核性胸腹膜炎患者的临床资料,结合相关文献进行复习与总结。资料：一青年女性患者,进行性腹胀、乏力、消瘦2月余,腹胀加重并伴有发热、盗汗。门诊体检提示胸腹腔积液。干预措施：行各项常规检查及胸片、T-SPOT、腹腔穿刺、腹水TB-DNA、全腹增强CT、胃镜、结肠镜、妇科B超、病理检查等以明确诊断,同时予以营养支持、提高免疫力及对症治疗,结合检查结果综合分析后予以诊断性抗结核治疗,并密切观察、随访。结果：全腹CT增强示：1.右侧胸腔积液并右肺下叶局限性不张,腹盆腔积液,腹膜增厚,肠系膜水肿,结合病史考虑结核性胸膜炎、结核性腹膜炎；2.肝左叶异常密度影,考虑结核可能；肠镜示回盲部溃疡,考虑肠结核,病检示回盲部粘膜组织慢性炎改变。诊断性抗结核治疗6周有效,最后诊断为肠结核合并肝结核、结核性胸腹膜炎。结论：肠结核、肝结核的临床表现没有特异性,需结PPD皮试、T-SPOT、腹水TB-DNA、结肠镜检查、全腹增强CT、组织病理学、组织细菌学等检查综合判断,可以提高诊断的准确性；必要时试验性药物治疗。
[Abstract]:Objective: to investigate the causes, clinical features, imaging examination and differential diagnosis of intestinal tuberculosis and hepatic tuberculosis, and to improve the diagnosis and treatment of intestinal tuberculosis and hepatic tuberculosis. Methods: the clinical data of a case with intestinal tuberculosis complicated with hepatic tuberculosis and tuberculous pleural peritonitis were reviewed and summarized. Data: a young female patient with progressive abdominal distension, fatigue, wasting for more than 2 months, aggravated abdominal distension with fever, night sweating. The physical examination of the outpatient department indicated hydrothorax and celiac effusion. Intervention measures: routine examination and chest film, T-SPOT, abdominal puncture, ascites TB-DNA, total abdominal enhanced CT, gastroscopy, colonoscopy, gynecological B-ultrasound, pathological examination, etc. To improve immunity and symptomatic treatment, combined with comprehensive analysis of the results of the diagnostic antituberculous treatment, and close observation, follow-up. Results: total abdominal CT showed: 1. Pleural effusion on the right side with localized atelectasis of the lower lobe of the right lung, abdominal and pelvic effusion, peritoneal thickening, mesenteric edema, tuberculous pleurisy, tuberculous peritonitis; 2. The abnormal density shadow of Zuo Ye of liver, considering the possibility of tuberculosis, and enteroscopy showing ileocecal ulcer, considering intestinal tuberculosis, showing chronic inflammation of mucosal tissue in ileocecal region. Diagnostic antituberculous treatment was effective for 6 weeks. The final diagnosis was intestinal tuberculosis with hepatic tuberculosis and tuberculous peritonitis. Conclusion: the clinical manifestations of intestinal tuberculosis and hepatic tuberculosis are not specific. It is necessary to make a comprehensive judgement on PPD skin test, T-SPOT, ascites TB-DNA, colonoscopy, total abdominal enhanced CT, histopathology, and bacteriological examination. It can improve the accuracy of diagnosis. Experimental drug therapy is necessary.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R52

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