Poyrazoglu Orhan K, Timurkaan Mustafa, Yalniz Mehmet, Ataseven Huseyin, Dogukan Muruvvet, Bahcecioglu Ibrahim H
Firat University Medical Center, Division of Gastroenterology, Elazig, Turkey.
J Dig Dis. 2008 Aug;9(3):170-4. doi: 10.1111/j.1751-2980.2008.00340.x.
To better identify which clinical, laboratory, radiological and invasive procedures were most useful in diagnosing tuberculous peritonitis and to assess the methods in order to reach the diagnosis in future cases.
Tuberculous peritonitis cases diagnosed between 2000 and 2006 were reviewed retrospectively. Their clinical presentation, physical examination, laboratory and diagnostic methods were evaluated.
Twenty-three cases oftuberculous peritonitis were diagnosed. The mean age of the patients were 30 +/- 11 years and 16 were women. The mean duration of symptoms prior to diagnosis was 3.6 months. All patients presented with abdominal pain. Abdominal swelling (91.3%), loss of appetite (87%) and weight loss (82.6%) were the other commonest symptoms. The major physical findings were ascites (78.3%) and fever (60.9%). The serum ascites albumin gradient was < 1.1 g/dL in all. An ascites fast bacilli smear was positive in 12 (52.2%) patients. Skin tests with purified protein derivative, adenosine deaminase and polymerase chain reaction were performed in seven, four and five patients, respectively. The tuberculous culture was positive in only two. The most common radiological findings were ascites (100%) and omental involvement (65.2%). A laparoscopy was performed in nine of 23 patients. A total of 22 patients completed anti-tuberculous therapy successfully and were cured, except one with cirrhosis.
Tuberculous peritonitis may be fatal but is medically cured if diagnosed in a timely fashion. Although both non-invasive and invasive tests have additional benefits, clinician suspicion is still the first step for the diagnosis of tuberculous peritonitis.
更好地确定哪些临床、实验室、放射学和侵入性检查方法对结核性腹膜炎的诊断最有用，并评估这些方法以便未来能对病例做出诊断。
对2000年至2006年间诊断的结核性腹膜炎病例进行回顾性分析。评估其临床表现、体格检查、实验室及诊断方法。
共诊断出23例结核性腹膜炎病例。患者的平均年龄为30±11岁，其中16例为女性。诊断前症状的平均持续时间为3.6个月。所有患者均有腹痛症状。腹部肿胀（91.3%）、食欲不振（87%）和体重减轻（82.6%）是其他最常见的症状。主要体格检查发现为腹水（78.3%）和发热（60.9%）。所有患者的血清腹水白蛋白梯度均<1.1g/dL。12例（52.2%）患者的腹水涂片抗酸杆菌阳性。分别对7例、4例和5例患者进行了结核菌素纯蛋白衍生物皮肤试验、腺苷脱氨酶检测及聚合酶链反应检测。仅2例结核培养呈阳性。最常见的放射学表现为腹水（100%）和网膜受累（65.2%）。23例患者中有9例行腹腔镜检查。除1例肝硬化患者外，共有22例患者成功完成抗结核治疗并治愈。
结核性腹膜炎可能致命，但如能及时诊断则可通过药物治愈。尽管非侵入性和侵入性检查均有额外的益处，但临床医生的怀疑仍是诊断结核性腹膜炎的首要步骤。
