TUBERCULOUS PERITONITIS - 43-YEARS EXPERIENCE IN DIAGNOSIS AND TREATMENT
TUBERCULOUS PERITONITIS - 43-YEARS EXPERIENCE IN DIAGNOSIS AND TREATMENT
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DOI：
10.1097/00000658-197612000-00010
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发表时间：
1976-01-01
影响因子：
9
通讯作者：
GRAFE, WR
中科院分区：
文献类型：
--
作者：
DINEEN, P;HOMAN, WP;GRAFE, WR
本文回顾了43年来70例结核性腹膜炎患者的临床病程。37例患者在抗结核化疗前确诊，33例在抗结核化疗后确诊。临床表现在研究期间保持不变。腹痛（93%）、发烧（63%）、胃肠不适（60%）、体重减轻（60%）和腹水（59%）仍然是最常见的表现。女性的数量是男性的2:1。89%的患者在诊断前症状持续时间为一周或更长，47%的患者持续时间超过一个月。44%的病例通过腹内组织的组织学检查确诊，29%的病例通过临床怀疑腹膜外部位有结核，24%的病例通过腹膜液细菌学检查确诊，3%的病例仅通过尸检确诊。83%的患者出现腹膜外结核。抗生素前的死亡率为49%，接受抗菌药物治疗的患者死亡率为7%，这强调了获得明确诊断和立即实施抗菌药物治疗的重要性。结论：1)临床表现提示，细菌学证据表明患者有活动性结核，不应强制手术；2)出现上述临床表现，且没有明确的细菌学证据时，建议进行剖腹探查诊断；3)抗结核化疗非常有效，是治疗的首选。
The clinical course of 70 patients with tuberculous peritonitis seen over a 43 year period has been reviewed. Thirty-seven patients were diagnosed prior to the advent of anti-tuberculous chemotherapy and 33 after. Clinical manifestations remained unchanged over the period of study. Abdominal pain (93%), fever (63%), gastrointestinal upset (60%), weight loss (60%), and ascites (59%) continue to be the most common findings. Females outnumbered males 2: 1. In 89% of patients the duration of symptoms prior to diagnosis was a week or longer, and in 47% it was longer than a month. Diagnosis was confirmed by histologic examination of intra-abdominal tissue in 44% of cases, by clinical suspicion with an extraperitoneal site of tuberculosis in 29%, by bacteriology of peritoneal fluid in 24%, and by autopsy alone in 3%. An extraperitoneal site of tuberculosis was present in 83% of patients. The importance of obtaining a definitive diagnosis, and of instituting immediate antimicrobial therapy is emphasized by the mortality of 49% in the pre-antibiotic era, and of 7% in patients receiving antimicrobial therapy. The conclusions from this review are that: 1) with suggestive clinical manifestations and bacteriologic proof of active tuberculosis anywhere in the patient, operation is not mandated; 2) in the presence of the above clinical manifestations, and in the absence of definitive bacteriologic proof, exploratory laparotomy is indicated for diagnostic purposes; 3) antituberculous chemotherapy is highly effective, and is the treatment of choice.