关键词: 结核, 腹腔, 外科手术, 对比研究

Abstract:

Objective: To investigate the effect of stage I operation on different types of abdominal tuberculosis. Methods: Clinical data of 75 abdominal tuberculosis patients treated with surgery in patients with tuberculosis from Shaanxi Tuberculosis Prevention and Control Hospital between January 1, 2016 and June 30, 2020 were collected. The diagnosis was confirmed by bacteriology or pathology. According to whether abdominal tuberculosis involves ≥2 abdominal organs, the patients were divided into pure group (n=37) and the composite group (n=38), the surgery conditions, postoperative complications, and the efficacy of surgery of the two groups were compared. Results: All the patients in the two groups were treated with stage I operation, 11 intestinal tuberculosis patients from the simple group underwent excision of ileocecal part the end of the cecum and ascending colon end to end anastomosis, 23 tuberculous peritonitis patients underwent removal of abdominal tuberculous abscess lesions, 3 patients with abdominal lymph node tuberculosis underwent mesenteric lymph node tuberculosis and removal of retroperitoneal lymph node tuberculosis kitchen. In the composite group, 4 patients were treated with intestinal perforation underwent perforation repair+abdominal abscess removal+intestinal adhesion release, and 15 intestinal tuberculosis patients complicated with tuberculous peritonitis underwent ileocecal intestinal resection and anastomosis+abdominal abscess removal+intestinal adhesion release, 19 intestinal tuberculosis patients complicated with tuberculous peritonitis and abdominal lymph node tuberculosis were treated with intestinal resection and anastomosis+abdominal abscess removal+mesenteric and retroperitoneal lymph node removal+intestinal adhesion release. Intraoperative blood loss, and operation time and postoperative drainage volume in the composite group were significantly higher than those in the simple group ((1271.84±66.28) ml vs. (594.32±35.92) ml, t=―8.986, P<0.001; 210.0 (145.0, 307.5) min vs. 80.0 (60.0, 90.0) min, Z=―6.839, P<0.001; and (1200.79±55.68) ml vs. (711.35±29.08) ml, t=―7.791, P<0.001, respectively). The incidence of incomplete obstruction in simple group was 16.2% (6/37), which was lower than that in composite group (63.2%, 24/38), and the difference was statistically significant (χ²=17.212, P<0.001). There was no intestinal perforation or intestinal fistula in the simple group. In the composite group, the incidence of intestinal perforation and fistula was 10.5% (4/38). Among them, 3 cases of fistula healed after anti-tuberculosis, nutritional support and dressing change drainage treatment, and the other one underwent cecal perforation enterectomy and anastomosis again. The patients in the two groups were followed up for 18-24 months, 1 case died (composite group) with the mortality rate of 1.3% (1/75), 6 cases were lost to follow-up, and 68 cases improved after treatment with the cure rate of 98.6% (68/69). Conclusion: Most of the patients with abdominal tuberculosis can achieve good surgical results. The intraoperative blood loss, operation time and postoperative drainage volume are higher in patients with abdominal tuberculosis involving a larger range of abdominal organs. Reasonable preoperative anti-tuberculosis, anti-infection and nutritional support therapy can reduce the incidence of postoperative complications.

Key words: Tuberculosis, Abdominal cavity, Surgical procedures, operative, Comparative study