CAJ | 학술논문

目的探讨纵隔淋巴结核侵犯食管的临床特点及诊疗方法,提高对该病的认识,减少误诊.方法回顾性分析8例纵隔淋巴结核侵犯食管患者的临床资料.男3例,女5例,年龄43～65岁,病程30d～1年,临床表现依次为:吞咽困难1例,进食哽噎感7例,胸痛2例.所有患者无其他部位结核证据.行内窥镜检查示:5例外压性改变,局限性管腔狭窄1例,此6例考虑为食管平滑肌瘤未取活检；溃疡型2例,取病理检查为慢性炎症,未能确诊为结核性病变.做上消化道钡餐造影,诊断食管平滑肌瘤6例,食管癌2例.术前误诊8例:食管平滑肌瘤6例,食管癌2例.手术治疗8例:纵隔淋巴结清扫术6例,术中冰冻病理示:淋巴结结核；2例行纵隔淋巴结清扫+食管结核切除并食管胃颈部吻合术,术中冰冻病理示:结核性溃疡.术后所有患者行正规抗结核治疗1年.结果 8例全部治愈.随访1～10年均无吞咽困难或结核复发.结论纵隔淋巴结核发病率低,而且纵隔淋巴结核逐渐长大压迫食管并向食管侵犯者非常罕见.临床症状缺乏特异性,影像学和内窥镜检查均难以确诊,很难与食管癌和食管良性肿瘤鉴别.当术前未能确诊,不能排除恶性肿瘤时,应手术治疗,术后继续抗结核治疗,术后长期生存质量优良.
목적 탐토종격림파결핵침범식관적림상특점급진료방법,제고대해병적인식,감소오진.방법 회고성분석8례종격림파결핵침범식관환자적림상자료.남3례,녀5례,년령43～65세,병정30d～1년,림상표현의차위:탄인곤난1례,진식경일감7례,흉통2례.소유환자무기타부위결핵증거.행내규경검사시:5예외압성개변,국한성관강협착1례,차6례고필위식관평활기류미취활검；궤양형2례,취병리검사위만성염증,미능학진위결핵성병변.주상소화도패찬조영,진단식관평활기류6례,식관암2례.술전오진8례:식관평활기류6례,식관암2례.수술치료8례:종격림파결청소술6례,술중빙동병리시:림파결결핵；2례행종격림파결청소+식관결핵절제병식관위경부문합술,술중빙동병리시:결핵성궤양.술후소유환자행정규항결핵치료1년.결과 8례전부치유.수방1～10년균무탄인곤난혹결핵복발.결론 종격림파결핵발병솔저,이차종격림파결핵축점장대압박식관병향식관침범자비상한견.림상증상결핍특이성,영상학화내규경검사균난이학진,흔난여식관암화식관량성종류감별.당술전미능학진,불능배제악성종류시,응수술치료,술후계속항결핵치료,술후장기생존질량우량.
Objective To investigate the clinical features and management of esophageal violated by mediastinal lymphoid tuberculosis and improve the recognization and reduce misdiagnosis of the disease.Methods The clinical datas of eight patients with esophageal violated by mediastinal lymphoid tuberculosis were reviewed,3 were male,5 were femal,age ranged from 43 to 65 years old,the course ranged from 30 days to 1 years.The symptoms include:dysphagia,choking feeling of eating,chest pain.All the patients had no evidence of tuberculosis(TB)in the other part of the body.All the patients had esophagoscopy,5 cases showed compressive changes,1 case showed the narrowing of local stenosis.The 6 patients diagnosed as leiomyoma of esophagus did not perform the biopsy,2 cases revealed ulcerative damges,biopsy showed chronic inflammation.All the patients found no evidence of TB under esophagoscopy and biopsy.All patients had barium swallows,6 patients revealed leiomyoma of esophagus,2 patients revealed esophageal carcinoma.Two patients were misdiagnosed as carcinoma of the esophagus and 6 patients were misdiagnosed as leiomyoma of esophagus before operation,and they were operated,6 patients underwent thoracotomy and mediastinal lymph node dissection,the intraoperative frozen pathology showed lymphatic ulcer.Two patients underwent mediastinal lymph node dissection and cervical and esophagogastric anastomosis,the intraoperative frozen pathology showed tuberculous ulcers.The antituberculous drugs were administered in all the patients for I year.Results All the patients recovered well,and were followed-up for 1-10 years,with no dysphagia or recurrence of tuberaulosis.Conclusions Mediastinal lymphoid tuberculosis is a rare disease,and esophageal violated by mediastinal lymphoid tuberculosis with gradually growing up is very rare.The clinical manifestations are not specific,radiology and endoscopy are difficult to confirm the diagnosis,and it is usually mistaken for the esophageal tumor.For the patients can not confirm the diagnosis,or other lesions can not be excluded,surgery should be considered,and the antituberculous drugs should be administered after operation.The quality of long-term survival are superior after operation.