中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2009年
9期
673-675
,共3页
沈振斌%刘厚宝%王炳生%童赛雄%艾志龙%锁涛
瀋振斌%劉厚寶%王炳生%童賽雄%艾誌龍%鎖濤
침진빈%류후보%왕병생%동새웅%애지룡%쇄도
结核%胆胰%胆胰恶性肿瘤%鉴别诊断
結覈%膽胰%膽胰噁性腫瘤%鑒彆診斷
결핵%담이%담이악성종류%감별진단
Tuberculosis,pancreatobiliary%Pancreatobiliary neoplasm%Differential diagnosis
目的 探讨胆胰部位结核的临床和病理特征,提高对该病的诊治水平.方法 回顾性分析复旦大学附属中山医院经手术证实的6例胆胰部位结核误诊为恶性肿瘤病例的临床资料.病人均为中青年,临床表现为黄疸、发热及腹痛.术前影像学检查提示局限性胆管狭窄伴近端肝内外胆管扩张;胆胰周围淋巴结结核病人还表现为胆胰周围实质性占位;胰腺结核病人可见胰头占位伴胰周淋巴结肿大;胆管结核病人胆管周围及十二指肠圈软组织影增多.6例术前均误诊癌肿而行手术探查由病理确诊,术后均予抗结核治疗.结果 经随访所有病例胆胰周围肿块明显缩小,黄疸、发热等临床症状消失.结论 胆胰部位结核与胆胰恶性肿瘤具有相似的临床表现和影像学特征,在术前难以鉴别,常需术中或术后病理检查确诊.经手术或内镜进行有效的支撑和引流胆道,术后积极的抗结核治疗是治愈胆胰结核的关键.
目的 探討膽胰部位結覈的臨床和病理特徵,提高對該病的診治水平.方法 迴顧性分析複旦大學附屬中山醫院經手術證實的6例膽胰部位結覈誤診為噁性腫瘤病例的臨床資料.病人均為中青年,臨床錶現為黃疸、髮熱及腹痛.術前影像學檢查提示跼限性膽管狹窄伴近耑肝內外膽管擴張;膽胰週圍淋巴結結覈病人還錶現為膽胰週圍實質性佔位;胰腺結覈病人可見胰頭佔位伴胰週淋巴結腫大;膽管結覈病人膽管週圍及十二指腸圈軟組織影增多.6例術前均誤診癌腫而行手術探查由病理確診,術後均予抗結覈治療.結果 經隨訪所有病例膽胰週圍腫塊明顯縮小,黃疸、髮熱等臨床癥狀消失.結論 膽胰部位結覈與膽胰噁性腫瘤具有相似的臨床錶現和影像學特徵,在術前難以鑒彆,常需術中或術後病理檢查確診.經手術或內鏡進行有效的支撐和引流膽道,術後積極的抗結覈治療是治愈膽胰結覈的關鍵.
목적 탐토담이부위결핵적림상화병리특정,제고대해병적진치수평.방법 회고성분석복단대학부속중산의원경수술증실적6례담이부위결핵오진위악성종류병례적림상자료.병인균위중청년,림상표현위황달、발열급복통.술전영상학검사제시국한성담관협착반근단간내외담관확장;담이주위림파결결핵병인환표현위담이주위실질성점위;이선결핵병인가견이두점위반이주림파결종대;담관결핵병인담관주위급십이지장권연조직영증다.6례술전균오진암종이행수술탐사유병리학진,술후균여항결핵치료.결과 경수방소유병례담이주위종괴명현축소,황달、발열등림상증상소실.결론 담이부위결핵여담이악성종류구유상사적림상표현화영상학특정,재술전난이감별,상수술중혹술후병리검사학진.경수술혹내경진행유효적지탱화인류담도,술후적겁적항결핵치료시치유담이결핵적관건.
Objective To determine the clinical, imaging and pathologic characteristics of pan-creatobiliary and peripanereatobiliary tuberculosis. Methods The clinical data of 6 patients (4 male, 2 female; mean age 41.3 yrs, range 24-54 yrs) with pancreatobiliary and peripancreatobiliary tuberculo-sis treated in Zhongshan Hospital of Fudan University were analyzed retrospectively. Main clinical presentations were abdominal pain, fever and jaundice. Chest X-rays revealed TB in only one patient. Imaging findings showed limited biliary stricture with dilation of the proximal bile duct and other ima-ging manifestations included peripancreatobiliary mass in peripancreatobiliary lymph nodes tuberculo-sis, mass in the head of pancreas with enlarged peripancreatic lymph nodes in pancreatic tuberculosis, abnormal soft tissues around bile duct and duodenum in bile duct tuberculosis. All the 6 cases were misdiagnosed as malignancies before laparotomy. Tuberculosis was confirmed by pathological examina-tion. Therapeutic approaches included bile duct drainage and anti-tubercular drugs for 6-12 months. Results All the 6 were followed up for 3 months to 12 years. No recurrence of tuberculosis was found in the pancreatobiliary and peripancreatobiliary region. Conclusion The manifestations of pancreato-biliary and peripancreatobiliary tuberculosis are mimicking with those of malignancies. The diagnosis of tuberculosis is usually not suspected prior to laparotomy. Tuberculosis should be considered as a differential diagnosis in younger patients with pancreaticobiliary and peripancreaticobiliary mass. Pan-creatobiliary and peripancreatobiliary tuberculosis can be effectively cured by effective bile duct drain-age and anti-tubercular drugs.