Can liver tuberculosis be treated?
summary
Hepatic tuberculous lesion is a kind of disease, which is rare compared with pulmonary tuberculosis. Due to the lack of specific symptoms and signs, the rate of misdiagnosis and mistreatment is high. So let's talk about the treatment of liver tuberculosis?.
Can liver tuberculosis be treated?
First, general treatment, proper rest, strengthen nutrition; Support treatment should be strengthened for the weak and seriously ill.
Second, the medical treatment of liver tuberculous lesions medication plan can refer to pulmonary tuberculosis, should be appropriate to extend the course of treatment. When patients with liver tuberculous lesions have abnormal liver function such as elevated ALT, it is not a contraindication of anti tuberculosis treatment, but an indication. ALT may fluctuate slightly during the course of treatment, but it will soon return to normal. Early use of anti tuberculosis drugs, commonly used for isoniazid, streptomycin, p-aminosalicylic acid (PAS), rifampicin and ethambutol. The course of isoniazid is usually 2 years and streptomycin is 3-6 months. Pas can be used for more than half a year according to the patient's reaction. At the same time, nutrition and systemic support should be strengthened. Antituberculosis chemotherapy should follow the principles of early, combined, moderate, regular and whole course medication. The method is the same as that of hematogenous disseminated tuberculosis. Short course chemotherapy under the supervision of who should be adopted. 2srhz / 4r3h3, 2erhz / 4r2h2, etc. can be selected for the specific scheme. The course of treatment is 6-9 months (s is streptomycin, h is isoniazid, R is rifampicin, Z is pyrazinamide, e is ethambutol, the number before the drug represents the number of months, and the number in the lower right corner after the drug represents the number of weekly medication). In the early stage, if high fever occurs, prednisone 10mg, three times a day can be added at the same time of effective anti tuberculosis drug treatment, and the dose can be reduced as soon as possible after fever subsides. Drug resistant tuberculosis, especially multidrug-resistant tuberculosis (MDR-TB), is the most difficult problem in clinical tuberculosis control. For the control of MDR-TB, the most important measure is to prevent its occurrence. For MDR-TB, effective treatment should be carried out as soon as possible. The plan should include at least 4 drugs, and 6-7 drugs if necessary. The decision should be made according to the lesion scope, drug efficacy, drug sensitivity test and previous medication history, and strive to be individualized. At the same time of active systemic antituberculosis treatment, repeated puncture and aspiration of abscess, irrigation of abscess cavity with 0.5% SM and injection of INH 50-100mg can accelerate the healing of abscess.
Third: surgical treatment for patients with tuberculous liver abscess, surgical drainage or hepatic lobectomy can be considered while effective antituberculous drug treatment. For patients with hepatic tuberculous lesions limited to one lobe of the liver, if there is no extrahepatic active tuberculosis and the liver function can tolerate surgery, hepatectomy can be performed after a period of anti tuberculosis drug treatment, and anti tuberculosis treatment should be continued after operation to prevent the spread of tuberculosis. The indications of surgical treatment are: (1) large solitary tuberculoma, tuberculous nodule fusion into mass or caseous liver abscess（ 2) Jaundice was caused by the compression of hepatic hilum（ 3) Portal hypertension complicated with esophageal variceal bleeding, or splenic tuberculosis, hypersplenism（ 4) Patients complicated with massive hemobilia（ 5) If the diagnosis is not clear, malignant diseases cannot be excluded.
matters needing attention
To control the source of infection, to discover and manage the source of infection is an important link in the work of tuberculosis prevention and control. It should be found and treated as early as possible. Therefore, regular collective lung health examination and registration management system should be implemented. To cut off the route of transmission, the first thing is to cure active pulmonary tuberculosis actively, as soon as possible and thoroughly, so as to turn sputum negative. The main methods of management and treatment of patients' sputum are as follows: carry out mass health campaign, widely publicize anti tuberculosis knowledge, develop good health habits, do not spit everywhere, sputum of tuberculosis patients should be spit on paper and burned, or cough in sputum cup, add 2% coal phenol soap or 1% formaldehyde solution (about 2 hours to sterilize), contact directly in the sun (several hours to sterilize).
