CLINICAL PICTURE, DIAGNOSTICS AND TREATMENT OF ABDOMINAL TUBERCULOSIS IN URGENT SURGERY
Rubrics: SURGERY & NEUROSURGERY
Authors:
1.
Irkutsk, Irkutsk region, Russian Federation
2.
Irkutsk, Irkutsk region, Russian Federation
Type:
Article
Pages:
from 82
to 85
Status:
Published
Received:
14.11.2017
Accepted:
30.11.2017
Published:
30.11.2017
Subject area:
UDK 61 Медицина. Охрана здоровья
Language:
Russian
Keywords:
abdominal'nyy tuberkulez, VICh-infekciya, neotlozhnaya hirurgiya
Abstract (English):
Abdominal'nyy tuberkulez predstavlyaet soboy redkuyu formu zabolevaniya. S serediny 1980-h godov otmechaetsya povsemestnyy rost zabolevaemosti tuberkulezom, chto privelo k obschemu rostu chisla bol'nyh abdominal'noy formoy tuberkuleza. Irkutskaya oblast' yavlyaetsya odnim iz samyh neblagopoluchnyh regionov Rossii po zabolevaemosti tuberkulezom i VICh-infekciey. Dlya ocenki klinicheskih proyavleniy zabolevaniya i rezul'tatov lecheniya proveden retrospektivnyy analiz 165 nablyudeniy abdominal'nogo tuberkuleza. Iz nih 95 % bol'nyh byli v vozraste 30–35 let, 80 % imeli VICh-infekciyu, podavlyayuschee bol'shinstvo veli asocial'nyy obraz zhizni. Veduschim proyavleniem zabolevaniya yavlyalsya bolevoy abdominal'nyy sindrom, kotoryy byl otmechen u 88,3 %. Dlya bol'nyh bylo takzhe harakterno nalichie i gipotonii (90; 54,5 %) i tahikardii (118; 71,5 %). Issledovaniya krovi pokazali u 132 (80,0 %) bol'nyh nalichie vypazhennoy gipoproteinemii. Pri rentgenologicheskom issledovanii grudnoy kletki u 97 (58,8 %) chelovek diagnostirovan disseminirovannyy tuberkulez legkih. Na obzornoy rentgenografii bryushnoy polosti u 49 (29,7 %) bol'nyh vyyavleno nalichie svobodnogo gaza pod diafragmoy, u 19 (11,5 %) – chashi Kloybera. Samymi chastymi oslozhneniyami abdominal'nogo tuberkuleza yavlyalis' perforacii yazv zheludochno-kishechnogo trakta. Oni diagnostirovany u 75 (53,7 %) bol'nyh. Drugie proyavleniya zabolevaniya (zheludochno-kishechnoe krovotechenie, tuberkuleznoe porazhenie limfaticheskih uzlov, selezenki, pecheni, bryushiny) vstrechalis' rezhe. Pokazaniem k operativnomu lecheniyu sluzhilo nalichie u bol'nogo priznakov peritonita. Operirovano 140 (84,5 %) bol'nyh. Obschaya letal'nost' sostavila 57,6 %. Osnovnoy prichinoy smertnosti byl obobschennyy tuberkulez. Provedennye issledovaniya pokazali, chto, kak pravilo, abdominal'nyy tuberkulez voznikaet u bol'nyh s disseminirovannym tuberkulezom legkih, imeyuschih VICh-infekciyu. Generalizaciya tuberkuleznogo processa v sochetanii s VICh-infekciey obuslavlivaet neblagopriyatnye ishody.
Abdominal'nyy tuberkulez predstavlyaet soboy redkuyu formu zabolevaniya. S serediny 1980-h godov otmechaetsya povsemestnyy rost zabolevaemosti tuberkulezom, chto privelo k obschemu rostu chisla bol'nyh abdominal'noy formoy tuberkuleza. Irkutskaya oblast' yavlyaetsya odnim iz samyh neblagopoluchnyh regionov Rossii po zabolevaemosti tuberkulezom i VICh-infekciey. Dlya ocenki klinicheskih proyavleniy zabolevaniya i rezul'tatov lecheniya proveden retrospektivnyy analiz 165 nablyudeniy abdominal'nogo tuberkuleza. Iz nih 95 % bol'nyh byli v vozraste 30–35 let, 80 % imeli VICh-infekciyu, podavlyayuschee bol'shinstvo veli asocial'nyy obraz zhizni. Veduschim proyavleniem zabolevaniya yavlyalsya bolevoy abdominal'nyy sindrom, kotoryy byl otmechen u 88,3 %. Dlya bol'nyh bylo takzhe harakterno nalichie i gipotonii (90; 54,5 %) i tahikardii (118; 71,5 %). Issledovaniya krovi pokazali u 132 (80,0 %) bol'nyh nalichie vypazhennoy gipoproteinemii. Pri rentgenologicheskom issledovanii grudnoy kletki u 97 (58,8 %) chelovek diagnostirovan disseminirovannyy tuberkulez legkih. Na obzornoy rentgenografii bryushnoy polosti u 49 (29,7 %) bol'nyh vyyavleno nalichie svobodnogo gaza pod diafragmoy, u 19 (11,5 %) – chashi Kloybera. Samymi chastymi oslozhneniyami abdominal'nogo tuberkuleza yavlyalis' perforacii yazv zheludochno-kishechnogo trakta. Oni diagnostirovany u 75 (53,7 %) bol'nyh. Drugie proyavleniya zabolevaniya (zheludochno-kishechnoe krovotechenie, tuberkuleznoe porazhenie limfaticheskih uzlov, selezenki, pecheni, bryushiny) vstrechalis' rezhe. Pokazaniem k operativnomu lecheniyu sluzhilo nalichie u bol'nogo priznakov peritonita. Operirovano 140 (84,5 %) bol'nyh. Obschaya letal'nost' sostavila 57,6 %. Osnovnoy prichinoy smertnosti byl obobschennyy tuberkulez. Provedennye issledovaniya pokazali, chto, kak pravilo, abdominal'nyy tuberkulez voznikaet u bol'nyh s disseminirovannym tuberkulezom legkih, imeyuschih VICh-infekciyu. Generalizaciya tuberkuleznogo processa v sochetanii s VICh-infekciey obuslavlivaet neblagopriyatnye ishody.
Keywords:
abdominal'nyy tuberkulez, VICh-infekciya, neotlozhnaya hirurgiya
abdominal'nyy tuberkulez, VICh-infekciya, neotlozhnaya hirurgiya
1. Klinika, diagnostika i lechenie abdominal'nogo tuberkuleza
