發(fā)布時間：2018-07-08 10:29

  本文選題：腸結(jié)核 + 診斷　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：通過15例臨床腸結(jié)核的臨床表現(xiàn)、實驗室檢查的結(jié)果并復習文獻對該類患者的誤診原因進行分析，以提高醫(yī)師對該類疾病的早期認知、識別，準確診斷，及時治療的能力，從而減少誤診。 方法：回顧性分析我院2008年3月至2013年10月共15例腸結(jié)核患者，因表現(xiàn)缺乏特異性被誤診，后經(jīng)腸鏡活檢或手術(shù)病理最終確診。 結(jié)果：本組腸結(jié)核患者15例，男6例，女9例，年齡14-64歲不等，平均年齡32.5歲；病程2個月-4年。誤診為克羅恩病5例、腹腔惡性腫瘤2例、急性腸穿孔并發(fā)腹膜炎1例、腸梗阻2例、盆腔炎1例、腸淋巴瘤1例，急性闌尾炎2例、貧血1例。10例初次結(jié)腸鏡檢查患者9例發(fā)現(xiàn)病灶，最終取活檢確診，余1例二次腸鏡取活檢確診，5例通過腹部手術(shù)病理確診。常見的臨床表現(xiàn)腹痛、發(fā)熱、結(jié)核中毒癥狀、腹瀉與便秘。最常見的并發(fā)癥為腸梗阻。腸結(jié)核好發(fā)部位為回盲部。所有患者均確診后轉(zhuǎn)入結(jié)核病院抗結(jié)核治療6-20個月不等，平均10.3個月，均獲隨訪，全部治愈，無因腸結(jié)核死亡病例。 結(jié)論：腸結(jié)核臨床表現(xiàn)無特異性加上病例少見，誤診率高，本組15例腸結(jié)核患者均為誤診病例。本病高發(fā)于青壯年，女性多于男性，，病變部位按好發(fā)率依次為回盲部、升結(jié)腸、回腸末端，橫降結(jié)腸。本組合并肺結(jié)核患者3例占20%。結(jié)腸鏡取活組織檢查及手術(shù)探查取病理為腸結(jié)核確診的重要手段，輔助檢查血常規(guī)、血沉、X線造影等檢查可提高腸結(jié)核確診率。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R524

【參考文獻】

相關期刊論文 前10條

1 王澤春;潘占勝;趙宏;;腸結(jié)核26例診斷與治療的臨床分析[J];結(jié)直腸肛門外科;2007年01期

2 江濤,盧春麗,李志強;重組人生長激素對結(jié)核外科術(shù)后患者營養(yǎng)狀況的影響[J];廣東醫(yī)學;2004年11期

3 白婕;張建;張學麗;;重癥腸結(jié)核58例外科治療體會[J];臨床肺科雜志;2010年05期

4 陳潤浩,章勇;腸結(jié)核致十二指腸橫結(jié)腸瘺及回腸盲腸瘺一例[J];臨床外科雜志;2003年01期

5 鄒寧,劉曉紅;腸結(jié)核與克羅恩病的鑒別診斷[J];胃腸病學;2003年05期

6 熊前榮;王華瑩;梅俊英;;結(jié)腸鏡檢查誤診13例腸結(jié)核臨床分析[J];實用臨床醫(yī)藥雜志;2008年05期

7 馬其彬;34例腸結(jié)核的臨床分析[J];中國防癆雜志;2004年05期

8 毛根軍,吳曉康,季敬偉,厲學民,沈蔚,羅建生,朱壽田,鄭樟棟;大腸結(jié)核20例誤診分析[J];中華消化雜志;2002年10期

9 繆應雷,歐陽欽,陳岱云,普蘋;內(nèi)鏡及病理學檢查在克羅恩病和腸結(jié)核鑒別診斷中的價值[J];中華消化內(nèi)鏡雜志;2002年01期

10 楊衛(wèi)文,楊景林,陳智;孤立性直腸結(jié)核12例臨床分析[J];中華消化內(nèi)鏡雜志;2002年02期

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