TUBERCULOUS PERITONITIS - A STUDY OF 47 PROVED CASES ENCOUNTERED BY A GENERAL MEDICAL UNIT IN 25 YEARS
TUBERCULOUS PERITONITIS - A STUDY OF 47 PROVED CASES ENCOUNTERED BY A GENERAL MEDICAL UNIT IN 25 YEARS
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DOI：
10.1016/0002-9343(60)90145-5
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发表时间：
1960-01-01
影响因子：
5.9
通讯作者：
HOLLISTER, RM
中科院分区：
文献类型：
--
作者：
BURACK, WR;HOLLISTER, RM
在过去的25年中，市立医院的医疗单位至少遇到了47次腹膜炎，并且频率不减。这很可能是不被怀疑的，特别是在同时患有肝硬化的患者中。对病理学和体格检查结果的研究表明，肝硬化腹水患者右上腹以外的其他部位出现腹痛、发热或腹部压痛，应引起对并存疾病的怀疑，结核性腹膜炎是其中一种可能。缺乏肺结核的物理或放射学证据与腹膜结核的诊断并不矛盾。腹水在物理、化学和细菌学上通常在正常范围内，但当总蛋白超过2.5g %或每立方毫米白细胞超过250个时，应考虑结核性腹膜炎的明显可能性，特别是当多形核细胞百分比低时。多形核白细胞持续超过30%使结核性腹膜炎不太可能诊断。几乎每3次豚鼠腹水接种中就有1次结核病阴性，超过一半的尝试分枝杆菌培养结果为阴性。因为有时一个是阳性的，而另一个是阴性的，所以当怀疑疾病时，有理由两者都做。在某些情况下，剖腹探查术是在合理时间内做出正确诊断的唯一方法。
Tuberculous peritonitis has been encountered at least 47 times by a medical unit of a municipal hospital, and with unabating frequency during the past 25 years. It was likely to go unsuspected, especially in patients who also had cirrhosis. Study of the symptomatology and physical findings demonstrated that abdominal pain, fever, or abdominal tenderness elsewhere than in the right upper quadrant in a patient who has cirrhosis with ascites should serve to raise the suspicion of coexisting disease, of which tuberculous peritonitis is one possibility. The absence of physical or radiologic evidence of pulmonary tuberculosis was by no means inconsistent with the diagnosis of peritoneal tuberculosis. The ascitic fluid is often physically, chemically and bacteriologically within normal limits, but when there are more than 2.5 g per cent total protein or more than 250 leukocytes per cu mm one should consider tuberculous peritonitis a 22737-22753 MEDICAL MICROBIOLOGY [Vol. 38] 1772 distinct possibility, particularly when the per cent of polymorphonuclear cells is low. The persistent finding of more than 30% polymorphonuclear leukocytes makes tuberculous peritonitis an unlikely diagnosis. Nearly one of every 3 ascitic fluid inoculations into guinea pigs was negative for tuberculosis, and more than half of the attempted mycobacterial cultures were negative. Because either was sometimes positive when the other was negative, there is reason to do both when the disease is suspected. In some cases exploratory laparotomy was the only means by which it was possible to establish a proper diagnosis within a reasonable time.