本文關(guān)鍵詞： 肛瘺 結(jié)核性肛瘺 肺結(jié)核 肛周膿腫 結(jié)直腸外科手術(shù)　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討抗結(jié)核治療和手術(shù)治療肺結(jié)核患者伴發(fā)結(jié)核性肛瘺的時(shí)機(jī)選擇及臨床療效分析。方法回顧性分析2008年1月-2016年1月新疆醫(yī)科大學(xué)第一附屬醫(yī)院和新疆維吾爾自治區(qū)胸科醫(yī)院肺結(jié)核患者伴發(fā)結(jié)核性肛瘺52例的臨床資料,根據(jù)抗結(jié)核治療前后手術(shù)時(shí)機(jī)的選擇分為先手術(shù)后抗結(jié)核治療組(A組)26例和先抗結(jié)核治療后手術(shù)組(B組)26例,進(jìn)行臨床相關(guān)指標(biāo)的對(duì)比分析。結(jié)果兩組患者在性別(x2=0.087、P=0.768)、年齡(t=0.231、P=0.389)、民族(x2=0.391、P=0.532)、病程(t=0.422、P=0.672)、隨訪時(shí)間(t=0.377、P=0.708)上差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。52例患者經(jīng)肛門�？茩z查檢出率為75%,聯(lián)合高頻彩超檢查檢出率為86.5%,對(duì)其中7例未檢出者行MRI檢查,檢出率為100%。B組肛瘺治療總體有效率為100.00%,明顯高于A組的76.92%(Zc=2.023,P=0.043)。B組術(shù)后相關(guān)指標(biāo)如術(shù)后疼痛評(píng)分(t=3.578、P=0.001)、術(shù)后疼痛時(shí)間(t=14.201、P=0.000)、術(shù)后愈合時(shí)間(t=3.782、P=0.000)及復(fù)發(fā)率(x2=4.127、P=0.042)差異有統(tǒng)計(jì)學(xué)意義(P0.05),明顯優(yōu)于A組;但在肛門括約肌功能(t=1.694、P=0.097)及生活質(zhì)量評(píng)分(t=1.870、P=0.067)上差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論肺結(jié)核患者伴發(fā)結(jié)核性肛瘺時(shí),應(yīng)在確診為肛瘺的基礎(chǔ)上以病理檢查或分泌物涂片和培養(yǎng)結(jié)果為金標(biāo)準(zhǔn),抗結(jié)核治療前后的手術(shù)時(shí)機(jī)選擇與患者預(yù)后有一定關(guān)系,先抗結(jié)核治療后手術(shù)治療可能對(duì)患者的預(yù)后有幫助。
[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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.16

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