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腹腔结核:临床特征和转归。

Abdominal tuberculosis: Clinical profile and outcome.

机构信息

Department of GI Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.

Department of Hepatology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.

出版信息

Int J Mycobacteriol. 2021 Oct-Dec;10(4):414-420. doi: 10.4103/ijmy.ijmy_195_21.

Abstract

BACKGROUND

Tuberculosis (TB) is common form of communicable disease in India. Abdominal TB is one of the most common yet misdiagnosed forms of extrapulmonary TB. It is missed due to its similarity to other conditions such as Crohn's disease and nonspecific clinical presentation.

METHODS

Medical records of 317 patients who were diagnosed with abdominal TB from August 2015 to December 2020 were reviewed retrospectively from our prospectively maintained database.

RESULTS

Among 317 patients, 167 (52.7%) were male. Median age of presentation was 45 (8-85) years. Luminal involvement was seen in most of the patients (n = 157, 49.5%), followed by peritoneal (n = 63, 19.8%), mixed (n = 42, 13.2%), solid visceral (n = 30, 9.4%), and nodal (n = 25, 7.8%) involvement. Two hundred and sixty-one (82.3%) showed complete response. Seven (2.2%) patients died and 5 (1.6%) patients lost to follow-up. Median duration of treatment was 28 (25-52) weeks. Drug-induced liver injury was identified in 30 (9.5%) patients. Median follow-up duration was 32 (1-70) months.

CONCLUSION

Abdominal TB is quite a diagnostic challenge due its vague clinical symptoms, nonspecific radiological features, and poor sensitivity and specificity of diagnostic tests. Hence, clinicians should have a high index of suspicion to diagnose and treat this treatable yet lethal condition promptly. Most cases respond very well to medical management and a small fraction requires surgical intervention if diagnosed early.

摘要

背景

结核病(TB)是印度常见的传染病形式。腹部结核病是最常见但易误诊的肺外结核病之一。由于其与克罗恩病和非特异性临床表现等其他疾病相似,因此常常被漏诊。

方法

我们回顾性地分析了 2015 年 8 月至 2020 年 12 月期间从我们前瞻性维护的数据库中诊断为腹部结核病的 317 名患者的病历。

结果

在 317 名患者中,有 167 名(52.7%)为男性。就诊时的中位年龄为 45 岁(8-85 岁)。大多数患者存在管腔受累(n = 157,49.5%),其次是腹膜受累(n = 63,19.8%)、混合受累(n = 42,13.2%)、实质内脏受累(n = 30,9.4%)和淋巴结受累(n = 25,7.8%)。261 名(82.3%)患者完全缓解。7 名(2.2%)患者死亡,5 名(1.6%)患者失访。中位治疗时间为 28 周(25-52 周)。30 名(9.5%)患者发生药物性肝损伤。中位随访时间为 32 个月(1-70 个月)。

结论

由于腹部结核病临床表现模糊、影像学特征不特异、诊断性检查的敏感性和特异性较差,因此诊断极具挑战性。因此,临床医生应高度怀疑该病,以便及时诊断和治疗这种可治疗但致命的疾病。大多数病例对药物治疗反应良好,极少数病例如果早期诊断,可能需要手术干预。

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