胰腺结核13例诊治体会  

Pancreatic tuberculosis: diagnosis and treatment of 13 cases

作　　者：宋扬[1] 刘全达[2] 许小亚[2] 周宁新[2] 

机构地区：[1]解放军总医院急诊科,北京100853 [2]解放军第二炮兵总医院肝胆外科,北京100088

出　　处：《局解手术学杂志》2013年第4期388-390,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的分析胰腺结核的临床特征,以提高胰腺结核的诊断水平,并给予及时、正确的治疗。方法回顾性分析2001年至2008年间诊治的13例胰腺结核患者的临床资料。结果本组男7例,女6例,中位年龄30岁,既往有结核病史4例,胸片异常3例。主要临床表现为:腹痛或不适8例,腰背痛5例,腹部包块4例,发热3例,黄疸3例,体重下降8例。超声和CT显示胰腺实性和囊实性肿瘤分别为8例和5例,孤立性胰腺结核6例。根据临床表现确定诊断1例,对8例行超声引导细针穿刺抽吸(FNA)活检11次,确诊5例,FNA的成功率为45%,FNA对胰腺结核患者的确诊率为63%(5/8);另7例经手术活组织病理检查确定诊断。全部病例接受规范的抗结核治疗后治愈,随访期间无复发。结论对年轻的胰腺占位性病变患者,怀疑胰腺结核的意识是提高诊断的关键,并进一步行超声引导下细针抽吸活检或术中活组织病理检查明确诊断。抗结核治疗能治愈胰腺结核,绝大部分病人可以避免手术干预。Objective To analyze the clinical characteristics of pancreatic tuberculosis, the diagnostic level of pancreatic tuberculosis was improved. Methods The data of 13 cases with pancreatic tuberculosis from 2001 to 2008 in our hospital were retrospectively reviewed. Results Of 13 patients, the ratio of male to female was 7 ： 6,the median age was 30. Four cases had history of tuberculosis, and 3 presented abnormal chest X-ray. The predominant symptoms consisted of abdominal pain or discomfort in 8 （62%）, lumbodorsal pain in 5 （ 36% ）, abdominal masses in 4 （31% ）, fever and night sweats in 3 （23 % ）, jaundice in 3 （23 % ） , and weight loss or anorexia in 8 （62%）. Abdominal ultrasound and computerized tomography （CT） revealed solid and cysto - solid tumors of pancreas respectively in 8 cases and 5 cases, as well as isolated pancreatic tuberculosis in 6 cases. One patient was diagnosed depending on clinical manifestations, 11 episodes of fine needle aspiration （FNA） were performed in 8 patients,and definite diagnosis was established in 5 cases,the rate of successful diagnosis by FNA was 63%. The other 7 patients obtained pathological confirmation by laparotomy or laparoscopic approach. All patients received regular antituber- culous therapy,with no recurrence during follow - up period. Conclusion Suspicion of tuberculosis and pathological evidence through FNA or surgical exploration are important for young patients with pancreatic masses in accurate diagnosis. Pancreatic tuberculosis can be cured by anti-tuberculous chemotherapy, operative intervention should be reserved to establish diagnosis or to deal with associated complications.

关 键 词：胰腺疾病 结核 鉴别诊断 细针抽吸活检 治疗 

分 类 号：R525[医药卫生—内科学]