病理剖検輯報の記載から見た腸結核の動向と問題点  [in Japanese] THE CURRENT STATUS AND PROBLEMS OF THE INTESTINAL TUBERCULOSIS THROUGH A REVIEW OF THE ANNUAL OF THE PATHOLOGICAL AUTOPSY CASES IN JAPAN  [in Japanese]

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Abstract

近年結核の罹患率は増加しており, それに伴い肺外結核も増加している。肺外結核の中で, 腸結核は, 多彩な臨床症状と診断が難しいことが知られており, また最近の医師の結核に対する意識の低下などから, 診断が必ずしも正確になされていないのではないかと思われた。そこで, 最近の腸結核の動向と問題点を探る目的で過去5年間の病理剖検輯報を検討した。<BR>140, 358症例中5, 103例 (3.6%) に結核, 陳旧性結核を認め, うち腸結核は80例 (0.057%, 男性45名, 女性35名, 平均年齢72.7歳) であった。また腸結核80例中71例 (88.8%) に肺結核を認めた。腸のみに病変があると考えられる症例は6例であり, 総剖検数に対し0.004%であった。部位は回盲部に多く認めた。病理診断上悪性腫瘍が併存する症例は14例 (17.5%) 17病変認めた。また, 臨床診断で結核と診断された症例は30例 (37.5%) のみであった。さらに臨床診断で腸閉塞, 便秘, 難治性下痢, 悪性腫瘍または悪性腫瘍の再発とされた症例に腸結核が関与していた。今後高齢化社会を迎えるにあたり, 診断の遅れは重篤な病態, 集団感染を引き起こす可能性があり, 日常診療の際にも肺結核や肺外結核について注意を払う必要がある。

From 1997 to 1999 the incidence rate of tuberculosis increased and extrapulmonary tuberculosis has also increased during the same period. Among various types of extrapulmonary tuberculosis, intestinal tuberculosis is one of the diseases difficult to diagnose. Recently doctors could not make appropriate diagnosis of intestinal tuberculosis because they did not pay much attention to tuberculosis. With a background described above, we reviewed the Annual of the Pathological Autopsy Cases in Japan in previous five years 1994-1998, in order to investigate a current status of intestinal tuberculosis. Out of 140, 358 autopsied cases, the number of cases with active and old tuberculosis was 5, 103 (3.6%), in which the intestinal tuberculosis was accompanied in 80 (0.057%). The 80 cases were consisting of 45 males and 35 females and their mean age was 72.7 years old ranging from 28 to 96. Of the 80 intestinal tuberculosis cases, 71 were seen in pulmonary tuberculosis cases and six cases were considered to be intestinal tuberculosis alone. In terms of the location of intestinal tuberculosis the most commonly affected site was ileocecum which occupied 72.7% of all intestinal tuberculosis. Among the 80 cases, 14 cases were complicated with malignant tumor and only 30 cases (37.5%) were diagnosed clinically as intestinal tuberculosis before their death. Clinical diagnosis of other cases were ileus, simple constipation, severe diarrhea, malignant tumor or its tumor. The delay in diagnosing intestinal tuberculosis may result in fatal outcome in the aged persons, so that in general practice much attention should be paid not only to pulmonary but also extrapulmonary tuberculosis including intestinal tuberculosis.

Journal

  • Kekkaku(Tuberculosis)

    Kekkaku(Tuberculosis) 77(4), 355-360, 2002-04-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

References:  26

Cited by:  9

Codes

  • NII Article ID (NAID)
    10008579523
  • NII NACSIS-CAT ID (NCID)
    AN00073442
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00229776
  • NDL Article ID
    026779584
  • NDL Call No.
    Z19-133
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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