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目的探讨产后腹腔结核的临床特点及漏诊原因。方法对2011—2014年我院收治的13例产后腹腔结核临床资料进行回顾性分析。结果本组分娩后平均1.6个月发病,主要表现为腹痛、腹胀、腹部包块、发热、食欲缺乏、体重进行性下降;部分病例伴有咳嗽、咳痰、胸痛、胸闷、气短、头痛、视物模糊。早期均漏诊,诊断为产褥感染,予抗生素抗感染及补液等对症治疗,但症状控制不理想,转我院后行剖腹探查,术后病理检查明确诊断为结核性腹膜炎13例,合并肠系膜淋巴结结核10例,合并肠结核4例。术后均予抗结核治疗,9例病情好转,4例因并发症死亡。结论产后腹腔结核容易误漏诊,应注意鉴别;对于合并腹腔包裹性脓肿或出现肠梗阻、可疑肠穿孔患者应积极剖腹探查,术后常规给予抗结核、抗感染治疗,以降低病死率。
Objective To investigate the clinical features and cause of missed diagnosis of postpartum abdominal tuberculosis. Methods The clinical data of 13 cases of postpartum abdominal tuberculosis admitted to our hospital from 2011 to 2014 were analyzed retrospectively. Results The average incidence of this group after 1.6 months of delivery, mainly abdominal pain, abdominal distension, abdominal mass, fever, loss of appetite, weight decline; some cases accompanied by cough, sputum, chest pain, chest tightness, shortness of breath, headache, visual Blurred Early missed diagnosis, diagnosis of puerperal infection, anti-infective antibiotics and rehydration and other symptomatic treatment, but the symptoms are not controlled, transferred to our hospital laparotomy, postoperative pathological examination was diagnosed as tuberculous peritonitis in 13 cases, with mesenteric lymph nodes Tuberculosis in 10 cases, 4 cases of intestinal tuberculosis. After anti-TB treatment, 9 patients improved, 4 patients died of complications. Conclusion Postpartum abdominal tuberculosis easily misdiagnosis, should pay attention to identification; for abdominal abscess combined with abdominal obstruction or intestinal obstruction, suspicious intestinal perforation should be actively laparotomy, postoperative conventional anti-TB, anti-infective treatment to reduce mortality.