【摘要】：目的：通過分析近9年來遵義醫(yī)學院附屬醫(yī)院（我院）及遵義市第一人民醫(yī)院60歲及以上的結(jié)核性腹膜炎患者的臨床特點，探討其診療方法，力求及時診斷，減少誤診、漏診率。 方法：選取遵義醫(yī)學院附屬醫(yī)院（我院）2005年2月至2014年2月60歲及以上結(jié)核性腹膜炎病例45例，以及遵義市第一人民醫(yī)院同期60歲及以上結(jié)核性腹膜炎病例53例，共計98例，集中對其臨床表現(xiàn)、輔助檢查、誤診及漏診情況進行回顧性分析、總結(jié)。 結(jié)果：老年性結(jié)核性腹膜炎患者多以腹痛、腹脹就診，其中腹痛約占83.67%，腹脹者約占81.63%，不同程度發(fā)熱者約占37.75%，納差、乏力者約占77.55%，只有8.16%-21.43%的患者伴有腹瀉、便秘、惡心、盜汗、消瘦表現(xiàn)。查體檢出有腹部柔韌感者約占33.67%，有腹腔積液體征者約占76.53%，腹部壓痛者約占83.67%，腹部包塊者約占3.06%。輔助檢查提示：腹水常規(guī)、生化檢查提示外觀均為淡黃色或無色渾濁液體，白細胞數(shù)＞500×106/L占95.58%，淋巴細胞為主占86.76%，李凡他試驗陽性占91.18%，腹水ADA＞45U/L占85.29%，腹水蛋白＞30g/L占82.35%，同期腹水蛋白/血清蛋白＞0.5占82.35%，同期腹水LDH/血清LDH＞0.6占82.35%。血沉增快者約占60.20%，血紅蛋白下降者約占66.32%，低蛋白血癥者約占82.65%，血清CA125增高者約占81.63%，抗結(jié)核抗體陽性者約占2.04%。給予抗癆治療后總有效率高達95.59%。98例中有誤診13例及漏診病例2例共15例，約占15.31%。98病例中男女比例為1：1.08，60-69歲62例，70-79歲28例，80歲及以上8例，合并腹膜外結(jié)核者25例，約占25.51%。 結(jié)論：（1）60歲及以上老年人群并非結(jié)核腹膜炎的好發(fā)人群，性別差異不顯著，男女比例接近，男：女為1:1.08。（2）合并腹膜外結(jié)核病例約占25.51%，其中以肺結(jié)核居多。（3）老年人群罹患結(jié)核性腹膜炎者以低熱、盜汗典型結(jié)核中毒癥狀就診者比例很少，該類患者往往多以腹痛、腹脹為首發(fā)或主要癥狀就診。超過90%患者合并不同程度腹腔積液。（4）腹腔積液細菌培養(yǎng)及腹膜活檢對結(jié)核性腹膜炎有確診意義，但在老年人群受檢率低，腹水常規(guī)、生化檢查，血沉、腹水腺苷脫氨酶（ADA）等檢查仍是綜合判斷診斷的常用有效輔助檢查。（5）老年性結(jié)核性腹膜炎誤診率、漏診率較高，不易與其他疾病鑒別時，可進行試驗性抗癆治療，以免延誤病情或?qū)е虏∏閻夯�。�?）觀察腹水、血清CA125、血沉的變化可用于判斷治療的有效性。（7）聯(lián)合使用口服抗癆藥治療老年性結(jié)核性腹膜炎仍是較有效的治療手段。
[Abstract]:Objective: to analyze the clinical characteristics of tuberculous peritonitis patients aged 60 years and above in affiliated Hospital of Zunyi Medical College and the first people's Hospital of Zunyi City in recent 9 years, and to explore the methods of diagnosis and treatment in order to make timely diagnosis and reduce misdiagnosis. Missed diagnosis rate Methods: Forty-five cases of tuberculous peritonitis aged 60 years and above and 53 cases of tuberculous peritonitis aged 60 years and above in the first people's Hospital of Zunyi Medical College from February 2005 to February 2014 were selected. The clinical manifestations, auxiliary examination, misdiagnosis and missed diagnosis were reviewed and summarized. Results: patients with senile tuberculous peritonitis were treated with abdominal pain, abdominal distension, abdominal pain accounted for 83.67, abdominal distension about 81.63, fever about 37.75, anorexia and fatigue about 77.55. Only 8.16-21.43% of the patients had diarrhea, constipation, nausea, night sweating. Wasting performance. The results showed that the abdominal flexibility was about 33.67m, the abdominal effusion was 76.53, the abdominal tenderness was 83.67, and the abdominal mass was 3.06. Auxiliary examination hint: ascites routine, biochemical examination indication appearance are all light yellow or colorless turbid liquid, The white blood cell count > 500 脳 10 ~ 6 / L accounted for 95.58%, the number of lymphocytes was 86.76, the positive rate of Li Fan test was 91.18, the ascites ADA > 45U/L was 85.29m, the ascites protein > 30g/L was 82.35, the ascites protein / serum protein > 0.5 was 82.35, and the ascites LDH/ serum LDH > 0.6 was 82.35. Erythrocyte sedimentation rate increased rapidly (60.20%), hemoglobin decreased (66.32%), hypoproteinemia (82.65%), serum CA125 increased (81.63%), anti-tuberculosis antibody positive (2.04%). The total effective rate was 95.59.98 cases misdiagnosed in 13 cases and missed diagnosis in 2 cases (15 cases). The ratio of male to female in 15.31.98 cases was 1: 1.0860-69 years old, 62 cases were 70-79 years old, 28 cases were 80 years old or above, 25 cases (25.51%) were complicated with extraperitoneal tuberculosis. Conclusion: (1) the elderly aged 60 years and above are not the most susceptible people with tuberculosis peritonitis, the sex difference is not significant, and the ratio of male and female is close. Male: female: 1: 1.08. (2) the incidence of extraperitoneal tuberculosis is about 25.51, of which tuberculosis is the most common. (3) the elderly people with tuberculous peritonitis suffer from low fever and few patients with typical symptoms of nocturnal sweating. Abdominal distension was the first or main symptom. More than 90% of the patients were complicated with different degrees of peritoneal effusion. (4) bacterial culture and peritoneal biopsy of peritoneal effusion were significant in diagnosis of tuberculous peritonitis, but in the elderly, the rate of detection was low, ascites routine, biochemical examination, erythrocyte sedimentation rate, Ascites adenosine deaminase (ADA) is still an effective assistant examination for comprehensive diagnosis. (5) the misdiagnosis rate and missed diagnosis rate of senile tuberculous peritonitis are high. (6) observation of ascites, changes of serum CA125, erythrocyte sedimentation rate can be used to judge the efficacy of treatment. (7) combined use of oral antituberculous drugs in the treatment of senile tuberculous peritonitis is still a more effective treatment.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R526

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