장결핵의 수술적 치료에 대한 임상적 고찰

초록

Background: Intestinal tuberculosis is often diagnosed in its late stage because the symptoms are not specific, so the disease has high mortality and morbidity. Appropriate surgical intervention and prompt initiation of anti-tuberculosis medications can successfully treat intestinal tuberculosis. The purpose of this article is to report the clinical characteristics of intestinal tuberculosis and to establish the surgical perspective. Methods: We retrospectively observed 60 patients who were pathologically proven to have had intes- tinal tuberculosis and who had been surgically treated at the Department of Surgery, Korea University Hospital, from Jan. 1985 to Dec. 1997. Results: The ratio of males to females was 1:1.22, and the peak incidence was the second and the third decades (60%). Clinical findings and physical examinations were not helpful for the preoperative diagnosis. Twenty-four patients (40%) had pulmonary tuberculosis. The correct diagnosis was made in only 31 of 60 patients (51.7%) prior to the operation. The frequently involved sites were the terminal ileum (53.3%), the cecum (38.3%), and the ascending colon (31.7%). Operative procedures were primarily resection of the involved segment and anastomosis. The complication rate was 25%, and 2 patients (3.3%) were died postoperatively. Conclusion: Intestinal tuberculosis must be included in the differential diagnosis of obscure abdominal conditions to avoid diagnosis delay, and surgery in combination with anti-tuberculosis medication is required to treat complications such as intestinal obstruction and perforation.

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