纵隔淋巴结结核侵犯食管8例临床分析  

Clinical analysis of 8 cases of esophageal violated by mediastinal lymphoid tuberculosis

作　　者：崔新征[1] 张清勇[1] 杨鲲鹏[1] 吉庆春[1] 

机构地区：[1]郑州大学第二附属医院胸外科,450014

出　　处：《中国实用医刊》2012年第2期29-31,共3页Chinese Journal of Practical Medicine

摘　　要：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倒，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。，晦床症状缺乏特异性，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。Objective To investigate the clinical features and management of esophageal violated by mediastinal lymphoid tuberculosis and improve the recoguization 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 esophagos- copy and biopsy. All patients had barium swallows, 6 patients revealed leiomyoma of esophagus, 2 pa- tients 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 pa- tients 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 antitu- berculous drugs were administered in all the patients for 1 year. Results All the patients recovered well, and were followed-up for 1 -10 years, with no dysphagia or recurrence of tuberaulosis. Conclu- sions 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.

关 键 词：纵隔淋巴结核 食管 抗结核治疗 

分 类 号：R522[医药卫生—内科学]