Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, College of Medicine, Taiwan.
Colorectal Dis. 2010 Jul;12(7 Online):e114-20. doi: 10.1111/j.1463-1318.2009.02057.x. Epub 2009 Oct 13.
Ano-perianal tuberculosis (TB) is a rare extrapulmonary form of the disease. Most publications are in case report form. We report our cohort retrospective study on ano-perianal TB, which is one of the very few original reports in the literature.
Over a period of 15 years (January 1992-December 2006), file records revealed cases with confirmed diagnosis of ano-perianal TB after screening from a total of 1251 patients with the diagnosis of TB from Chang Gung Memorial Hospital-Kaohsiung, Taiwan.
This study recruited 17 patients (14 male patients and 3 female patients). The age ranged from 18 to 81 years with a mean age of 44.8 +/- 18.2 years. Thirteen patients had coexistent pulmonary TB (76.5%). Eight patients had at least one concomitant co-morbid illness (47.1%). The most common clinical manifestations were anal fistulae (n = 16). All patients who completed a full course of anti-mycobacterial treatment for at least 6 months after surgical intervention were cured without recurrence except for one patient who was lost to follow-up after 2 months of treatment. Seven of the nine patients with complicated fistulae needed longer anti-mycobacterium treatment duration (9-18 months).
Ano-perianal TB should be kept in mind for all patients with prolonged or repeatedly recurrent ano-perianal symptoms and signs such as complicated fistulae in an endemic TB area like Taiwan. Management strategy is with conventional anti-mycobacterium therapy for at least 6 months after surgery. An extension of the anti-mycobacterium treatment course to 9-18 months is mandatory for patients with complicated disease presentations.
肛门直肠结核（TB）是一种罕见的肺外疾病形式。大多数出版物以病例报告的形式出现。我们报告了我们的队列回顾性研究，这是文献中为数不多的原始报告之一。
在 15 年的时间内（1992 年 1 月至 2006 年 12 月），通过从台湾长庚纪念医院-高雄的 1251 例 TB 诊断患者中进行筛选，病历记录显示有确诊的肛门直肠 TB 病例。
本研究共纳入 17 例患者（14 例男性患者和 3 例女性患者）。年龄范围为 18 至 81 岁，平均年龄为 44.8 +/- 18.2 岁。13 例患者合并肺结核（76.5%）。8 例患者至少伴有一种并存的合并症（47.1%）。最常见的临床表现为肛门瘘（n = 16）。所有完成至少 6 个月抗分枝杆菌治疗的患者在手术干预后均治愈，无复发，除 1 例患者在治疗 2 个月后失访外。9 例复杂瘘管患者中有 7 例需要更长的抗分枝杆菌治疗时间（9-18 个月）。
对于所有在台湾等地方性结核病地区出现长期或反复出现肛门直肠症状和体征（如复杂瘘管）的患者，应考虑肛门直肠 TB。治疗策略是在手术后常规进行至少 6 个月的抗分枝杆菌治疗。对于有复杂疾病表现的患者，抗分枝杆菌治疗疗程延长至 9-18 个月是必要的。
