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目的探讨脾结核的诊断及治疗措施。方法对18例脾结核患者的临床资料进行回顾性分析。结果18例病人中表现为发热14例(占77.7%),腹痛9例(占50.0%),发热病程为1周至12个月,平均热程为2个月。其他较常见症状体征为腹胀4例(占22.2%)、盗汗4例(22.2%)、乏力5例(占27.8%)、纳差7例(38.9%)、贫血7例(38.9%)、脾肿大9例(占50%)。手术及病理诊断12例,1例胃液发现抗酸杆菌确诊,5例经试验性抗结核治疗有效确诊。18例病人中10例合并脾外结核。确诊前误诊9例(50%)。2例病人死亡,余16例均经手术及或1年以上的抗结核治疗,经随访预后良好。结论脾结核以长程发热和腹痛为突出表现,误诊率高,诊断主要依靠脾切除病理学检查及诊断性治疗,选择性手术治疗及系统性抗结核治疗是脾结核的主要有效治疗手段。
Objective To investigate the diagnosis and treatment of splenic tuberculosis. Methods The clinical data of 18 patients with splenic tuberculosis were retrospectively analyzed. Results In 18 patients, 14 cases (77.7%) had fever and 9 cases (50.0%) had abdominal pain. The course of fever was from 1 week to 12 months with an average heat duration of 2 months. Other common symptoms and signs were abdominal distension in 4 cases (22.2%), night sweats in 4 cases (22.2%), fatigue in 5 cases (27.8%), anorexia in 7 cases (38.9%), anemia in 7 cases (38.9%), spleen Swollen in 9 cases (50%). 12 cases were diagnosed by operation and pathology. One case of gastric juice was diagnosed as acid-fast bacilli, and 5 cases were confirmed by experimental anti-tuberculosis treatment. Ten of 18 patients had splenic tuberculosis. Nine cases were misdiagnosed before diagnosis (50%). Two patients died, more than 16 cases were treated by surgery and or more than 1 year of anti-TB treatment, the prognosis was good after follow-up. Conclusion Splenic tuberculosis with long-range fever and abdominal pain as the outstanding performance, misdiagnosis rate, diagnosis depends mainly on splenectomy pathology and diagnostic treatment, selective surgical treatment and systemic anti-TB therapy is the main effective treatment of splenic tuberculosis.