【摘要】 目的比较不同等级医院间结核性腹膜炎(TBP)临床诊断方法的差异性,提高各级医院临床医师对TBP的诊断水平。方法收集镇江地区8家二、三级医院近五年住院确诊TBP病例的临床资料,按医院等级分为二级医院组10例,三级医院组29例,收集两组特异性诊断指标、诊断方法、入院初步诊断进行统计学处理。结果组间比较特异性实验室诊断指标无统计学差异(P>0.05),三级医院组腹部B超及CT诊断优于二级医院组,具有统计学差异(P<0.05);组间比较诊断方法无统计学差异(P>0.05),但腹腔镜辅助诊断方法集中在三级医院开展,诊断不明又难以排除腹腔肿瘤时采用剖腹探查,三级医院组诊断性治疗起始时间早于二级医院组,具有统计学差异(P=0.02);三级医院组入院初步诊断TBP准确率优于二级医院组,但无统计学差异(P>0.05),其他初步诊断均无统计学差异(P>0.05)。结论对于不能排除及高度疑似TBP患者各级医院应完善规范辅助检查,推行多学科综合治疗(MDT)模式丰富TBP诊断方法,诊疗中综合合理分析以达到早期诊断和治疗。更多还原

【Abstract】 Objective To compare the differences in the clinical diagnosis of tuberculous peritonitis( TBP) between different grades of hospitals and to improve the diagnostic level of TBP at all levels of hospital clinicians. Methods Collected the clinical data of diagnosing the TBP cases in eight secondary and tertiary hospitals in nearly five years of Zhenjiang,including 10 cases in secondary level hospitals,29 cases in the third level hospitals. Collected and analyzed the specific diagnosis index of two groups,diagnosis methods,and the preliminary diagnosis. Results There was no statistical significance between groups in specific laboratory diagnosis index( P > 0. 05). The third level hospitals is better than the secondary level hospital in abdominal ultrasound and CT diagnosis,had statistical difference( P< 0. 05); There was no statistical significance between groups in diagnosis methods( P>0.05),but focused on the third level hospitals in laparoscopic assisted diagnosis methods,the diagnosis was unknown and difficult to eliminate abdominal tumor by laparotomy,third level hospital diagnostic treatment group was obviously earlier than the time of the secondary level hospital group,with statistical difference( P = 0.02); The TBP preliminary diagnosis accuracy in the third level hospital group was better than that of the secondary level hospital admission,but not statistically significant( P > 0. 05),and other primary diagnosis were not statistically significant( P > 0. 05). Conclusions For patients unable to exclude and highly suspected TBP,hospitals at all levels should improve the standardized auxiliary examination,hospitals should carry out multidisciplinary integrated therapy( MDT) model to enrich TBP diagnostic methods,and make reasonable and comprehensive diagnosis and treatment in order to achieve early diagnosis and treatment.更多还原