内科学肠结核课件.ppt

肠 结 核intestinal tuberculosis 浙江大学医学院附属第一医院消化内科 【概念】conception 肠结核是结核杆菌侵犯肠道引起的慢性特异性感染． Chronic and specific infection caused by Mycobacterium tuberculosis invaded intestinal 通常继发于肠外结核灶，特别是排菌性肺结核，少数（约10%）原发于肠道，称之原发性肠结核 Secondary intestinal tuberculosis Primary intestinal tuberculosis(10%) 【病因和发病机制】 etiopathogenisis and pathogenesis （一）病因： etiopathogenisis 　　　特异性病原菌绝大多数为人型结核杆菌，　少数为牛型结核杆菌 M. tuberculosis ---majority Mycobacterium bovis ---minority （二）侵犯途径 mode of spread 1．胃肠道感染　最常见、最主要的途径 Gastrointestinal infection: common and main 2．血行播散 hematogenous dissemination 最常见是粟粒型肺结核 phthisis miliaris 3．直接蔓延 direct spread 　 【病理】 pathology 肠结核好发部位绝大多数在回盲部（80～90%），其他部位依次为升结肠、回肠、空肠、阑尾、横结肠、降结肠、十二指肠、乙状结肠、直肠、胃、食管Predilection site :Mostly----ileocecal junction. Others:ascending colon; ileum; jejunum; appendix ; transverse colon; transverse colon; duodenum; sigmoid colon; rectum; stomach; esophagus. 溃疡型肠结核 ulcerative tuberculosis of intestine 增生型肠结核 hyperplastic tuberculosis of intestines 混合型或溃疡增生型肠结核mixed tuberculosis of intestines 【临床表现】 Clinical Manifestations （一）腹痛 abdominal pain 　 80～90% 部位与病变部位有关 80-90% pain location concerned with the diseased region. （二）腹泻与便秘 diarrhea and constipation 　30%病人可出现腹泻与便秘交替，为肠功能紊乱所致 30% : diarrhea and constipation alternation, caused by intestinal functional disorder （三）腹块　 abdominal mass （四）全身中毒症状和肠外结核的表现 systemic toxemia and extra-intestinal tubercular signs and symptoms （五）并发症的表现肠梗阻、肠穿孔、瘘管形成及便血等 complication: intestinal obstruction; enterobrosis; fistula; hemafecia 【实验室和其他检查】laboratory and other examination （一） 实验室检查laboratory examination 贫血,红细胞沉降率明显加速，结核菌素实验阳性 Anaemia; ESR↑; PPD: positive （二） X线检查及肠镜检查:重要 . 溃疡性肠结核钡剂在病变肠段激惹征象 X-ray and enteroscopy are important. Irritation sign X线钡剂激惹征 结肠镜检查： 病灶处活检，发现干酪样肉芽肿或找到抗酸杆菌有确诊意义。 【诊断与鉴别诊断】 Diagnosis and Differential Diagnosis 1．青壮年发病，有肠外结核灶存在 young , extra-intesti