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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 133 -137. doi: 10.3877/cma.j.issn.1674-1358.2021.02.011

所属专题: 经典病例

病例报告

获得性免疫缺陷综合征合并肠结核引起肠穿孔一例并文献复习
周莹莹1, 罗峻2, 田素芳2, 熊勇1,()   
  1. 1. 430071 武汉市,武汉大学中南医院感染科
    2. 430071 武汉市,武汉大学中南医院病理科
  • 收稿日期:2020-08-22 出版日期:2021-04-15
  • 通信作者: 熊勇
  • 基金资助:
    "十三五"艾滋病和病毒性肝炎等重大传染病防治科技重大专项(No. 2017ZX10202101-001)

A case of intestinal perforation due to intestinal tuberculosis complicated with acquired immunodeficiency syndrome and relevant literature review

Yingying Zhou1, Jun Luo2, Sufang Tian2, Yong Xiong1,()   

  1. 1. Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
    2. Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  • Received:2020-08-22 Published:2021-04-15
  • Corresponding author: Yong Xiong
引用本文:

周莹莹, 罗峻, 田素芳, 熊勇. 获得性免疫缺陷综合征合并肠结核引起肠穿孔一例并文献复习[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(02): 133-137.

Yingying Zhou, Jun Luo, Sufang Tian, Yong Xiong. A case of intestinal perforation due to intestinal tuberculosis complicated with acquired immunodeficiency syndrome and relevant literature review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(02): 133-137.

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。

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.

图1 患者腹部CT图片
图2 2018年1月2日患者小肠组织病理活检
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