【摘要】 目的探讨获得性免疫缺陷综合征(AIDS)合并肠结核引起肠穿孔的治疗。方法分析1例AIDS合并肠结核引起肠穿孔患者的诊疗经过,并结合相关文献进行复习。结果 1例CD4~+T细胞为15个/μl的43岁AIDS女性患者因间断发热于2017年12月28日至武汉大学中南医院住院诊治,住院后次日出现肠穿孔,急诊行"开腹探查术+回肠部分切除术+回肠-回肠端端吻合术",病理标本提示肠结核,给予抗感染等综合对症治疗,病情缓解,预后较好。结论 AIDS合并肠穿孔患者,保守治疗失败,伴随着症状持续和(或)脓毒症的发展,尽管CD4~+T细胞计数低下,应及时手术,术后行有效抗感染、抗结核综合治疗并适时启动抗逆转录病毒治疗,可改善患者预后。更多还原

【Abstract】 Objective To investigate the treatment of intestinal perforation due to intestinal tuberculosis in a patient with acquired immunodeficiency syndrome(AIDS). Methods The diagnosis and treatment of a case of intestinal perforation due to intestinal tuberculosis complicated with AIDS were analyzed. The relevant literatures were reviewed. Results On December 28, 2017, a 43-year-old female AIDS patient with CD4~+ T as 15 cells/μl was admitted to Zhongnan Hospital of Wuhan University due to intermittent fever. On the next day after hospitalization, emergency treatment of "exploratory laparotomy + partial ileum resection + terminal-terminal anastomosis" were performed to the case of intestinal perforation. The pathological specimen showed intestinal tuberculosis. After anti-infection and comprehensive symptomatic treatment, the condition of the case relieved and the prognosis was relatively well. Conclusions The conservative treatment of AIDS patients with intestinal perforation failed, accompanied by persistent symptoms and(or) development of sepsis. Although the CD4~+ T count was low, timely surgical intervention, effective postoperative anti-infection, anti-tuberculosis and initiation of antiretroviral therapy at the right moment could improve the prognosis.更多还原