目的：探讨腹腔药物灌注方法治疗渗出型结核性腹膜炎的效果。 方法：回顾分析3年半间诊治的69例以渗出为主的结核性腹膜炎患者的临床资料。其中36例行全身化疗的同时给予腹腔灌注抗结核药（雷米封和丁胺卡那）和降纤酶治疗，视为观察组; 另外33例仅行全身化疗，作为对照组。对比两组治疗后发热持续时间、腹痛缓解时间、腹水消除时间、肠梗阻发生率,以及治疗后1，2周2个时点所测定的C-反应蛋白（CRP），腺苷脱氨酶（ADA）活性，血浆腹水蛋白梯度值（SAAG）的变化。 结果：观察组发热持续时间腹痛消除时间和腹水消除时间均显著短于对照组（P＜0.01）; 肠梗阻发生率亦低于对照组（P＜0.01）; 治疗1周后两组CRP，ADA，SAAG水平无统计学差异（P>0.05); 治疗2周后观察组CRP和ADA水平明显低于对照组，SAAG高于对照组，差异均有统计学意义（P＜0.05）。 结论：全身联合腹腔灌注抗结核药有利于结核性腹膜炎的恢复; 灌注降纤酶能有效减轻粘连，减少粘连性肠梗阻的发生。
Objective：To investigate the effects of intraperitoneal drug perfusion for treating exudative tuberculous peritonitis. Methods：The clinical data of 69 patients with exudative tuberculous peritonitis treated in our hospital within three and a half years were analyzed retrospectively. Thirty-six cases in the observation group were given systemic antituberculotic therapy combined with intraperitoneal perfusion of isoniazid, mikacin and defibrase. The other 33 cases in control group received systemic antituberculotic tharapy only. The indexes including duration of fever, time for abdominal pain remission and ascites elimination, and incidence rate of intestinal obstruction between two groups after treatment was compared. The levels of C-reactive protein (CRP), adenosine deaminase (ADA) and serum-ascitic albumin gradient (SAAG) 1 and 2 week after treatment were also analyzed. Results：The duration of fever, time for abdominal pain remission and ascites elimination as well as the incidence rate of intestinal obstruction in the observation group were significantly decreased compared with those of the control group (P＜0.01). No differences were observed in the levels of CRP, ADA and SAAG between two groups at the time point of 1 week after treatment (P>0.05), but the levels of CRP and ADA were significant lower, while SAAG level was singnificantly higher in the observation group than that of the control group at the time point 2-week after treatment (P＜0.05). Conclusions：Systemic therapy combination with intraperitoneal perfusion with antituberculotic drugs is beneficial for the healing of tuberculous peritonitis, and along with defibrase can effectively lessen adhesion formation, thus reducing the incidence of adhesive intestinal obstruction.
张建, 白婕, 李志华, 刘晓东, 李强.腹腔药物灌注治疗结核性腹膜炎的价值[J].中国普通外科杂志,2011,20(5):526-528.复制