Stupart Douglas, Goldberg Paul, Levy Anthony, Govender Dhiren
Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town.
S Afr J Surg. 2009 Nov;47(4):116-8.
The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulas.
This was a prospective study of all patients who underwent surgery for anal fistulas at the Colorectal Surgery Unit at Groote Schuur Hospital, Cape Town, from 2004 to 2006. Tissue was submitted for histopathological examination, Ziehl-Neelsen (ZN) staining and TB culture. The patients with proven TB were followed up until January 2008.
During the 3-year study period, 117 operations were performed on 96 patients. TB was diagnosed in 7 of the 96 patients (7.3%). In 5 of these 7 cases, the diagnosis of TB could be proven on histological examination and ZN staining, while in 2 cases the diagnosis could only be made on TB culture. None of the 7 patients had systemic features suggestive of TB, and only 1 had evidence of TB on a chest radiograph, Five patients were HIV-negative, and 2 declined testing. After a median follow-up of 2 years, 5 of 7 patients had evidence of recurrent or persistent fistulas, despite having completed 6 months of TB treatment.
At a referral hospital in an endemic area, TB was present in 7.3% of anal fistulas. Histopathological examination including ZN staining was inadequate to make the diagnosis in a third of these patients. Tissue from anal fistulas should therefore routinely be sent for TB culture as well as histopathological examination and ZN staining in areas where TB is prevalent.
本研究的目的是确定开普敦一家转诊医院肛瘘患者中结核病（TB）的患病率，并记录结核性肛瘘患者的临床特征和病程。
这是一项对2004年至2006年在开普敦格罗特舒尔医院结直肠外科接受肛瘘手术的所有患者进行的前瞻性研究。提交组织进行组织病理学检查、齐-尼（ZN）染色和结核菌培养。确诊为结核病的患者随访至2008年1月。
在为期3年的研究期间，对96例患者进行了117次手术。96例患者中有7例（7.3%）被诊断为结核病。在这7例中的5例中，通过组织学检查和ZN染色可证实结核病诊断，而在2例中仅通过结核菌培养做出诊断。7例患者均无提示结核病的全身特征，只有1例胸部X线片有结核病证据。5例患者HIV检测为阴性，2例拒绝检测。中位随访2年后，7例患者中有5例尽管已完成6个月的结核病治疗，但仍有肛瘘复发或持续存在的证据。
在流行地区的一家转诊医院，7.3%的肛瘘患者患有结核病。包括ZN染色在内的组织病理学检查在三分之一的此类患者中不足以做出诊断。因此，在结核病流行地区，肛瘘组织应常规送检进行结核菌培养以及组织病理学检查和ZN染色。
