孤立性直肠结核1例并文献复习

Isolated rectal tuberculosis： a case report and review of literature

摘要:

目的：报告1例孤立性直肠结核患者的诊治过程，并综合国内外文献进行讨论，以提高对此病的认识。方法：对本院收治的1例孤立性直肠结核患者的临床表现、实验室检查、内镜及病理资料、诊断和治疗进行分析，并结合文献加以讨论。结果：本例患者以腹痛、排脓血便及消瘦入院，肠镜提示孤立性直肠巨大溃疡，病理检查未发现干酪样肉芽肿和抗酸杆菌，粪便细菌培养和结核杆菌聚合酶链反应（tuberculosis polymerase chain reaction，TB-PCR）阴性，结核菌素纯蛋白衍生物（tuberculin purified protein derivative，TB-PPD）+++，未见直肠外结核感染证据。诊断性抗结核治疗3个月后患者临床症状明显缓解，内镜下直肠溃疡较前好转，持续规范抗结核治疗15个月后痊愈，随访至今未见复发。结论：孤立性直肠结核临床罕见，缺乏特异的临床、影像及内镜下表现，易导致误诊。病理发现干酪样肉芽肿和抗酸杆菌阳性率低；结核菌素试验和诊断性抗结核简单、有效，对提高结核诊断率仍有重要意义。

Abstract:

Objective：To report a case of isolated rectal tuberculosis（TB），and to made a literature review to improve the understanding of this rare condition. Methods：The data of clinical features，laboratory examinations，endoscopic manifestations，pathological charac－teristics，diagnosis and therapy of one patient with isolated rectal TB in our hospital were collected. Moreover，literature was summa－rized and compared. Results：The patient was hospitalized for abdominal pain，bloody purulent stool and emaciation. Endoscopy showed a huge isolated rectal ulcer. However，histopathologic biopsy found no caseating granuloma or acid-fast bacilli. Multiple acid-fast stool cultures and TB polymerase chain reaction（TB-PCR） assay were also negative. But the tuberculin purified protein derivative （TB-PPD） skin test was strongly positive. In addition，there was no evidence of parenteral tuberculosis infection. Moreover，after 3 months of diagnostic anti-TB treatment，the patient had a clinical remission. Endoscopy revealed the rectal lesion was much improved. The rectal ulcer was healed after a continuous anti-TB therapy of 15 months，no recurrence was occurred up to now. Conclusion：Iso－lated rectal TB is a rare disease without characteristic clinical，imaging and endoscopic features. The positive rates of caseating granu－loma or acid-fast bacilli found by histopathologic biopsy are rather low. However，TB-PPD test and diagnostic anti-TB treatmet are simple but effective strategies，which have important value for increasing the diagnosing rate of TB.