胆管结核误诊为壶腹周围癌一例并文献复习  

Biliary Tuberculosis Misdiagnosed as Periampullary Carcinoma: a Case Report and Literature Review

作　　者：何彦安[1] 丁辉[1] 蔡岷[1] 曾勇[1] 蔡宇[1] 何永红[1] 

机构地区：[1]江油市人民医院肝胆外科,四川江油621700

出　　处：《临床误诊误治》2014年第7期42-44,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨胆管结核的临床特征及诊治经验,以减少误诊误治。方法回顾性分析胆管结核误诊为壶腹周围癌1例的临床资料,并复习相关文献。结果本例因上腹部胀痛1个月,腹痛加重伴黄疸6 d入院。入院后彩色多普勒超声提示胰头部不规则实性占位性病变,胆囊增大并胆总管扩张;腹部CT示肝十二指肠韧带淋巴结增大。拟诊为壶腹周围癌行胰十二指肠切除术,术后病理诊断为胆总管下段结核。术后予抗结核治疗,随访2年无复发。结论胆管结核临床少见,极易误诊,临床诊断主要依靠病理学和微生物学检测。Objective To explore clinical characteristics and experience in diagnosis and treatment of biliary tubercu-losis （BTB） in order to avoid misdiagnosis and mistreatment. Methods Clinical data of a patient with BTB misdiagnosed as having periampullary carcinoma was retrospectively analyzed, and related literature was reviewed. Results The patient was admitted for abdominal gas pain for one month and aggravated abdominal pain combined with jaundice for 6 days. Irregularity occupying lesions in pancreatic head, enlargement gallbladder and choledochectasia were found by color Doppler ultrasonogra-phy examination, and enlarged duodenohepatic ligament of lymph node was found by CT scan. Periampullary carcinoma was diagnosed, and pancreatoduodenectomy was performed, and then choledochus segment inferior tuberculosis was confirmed by postoperative pathological result. The patient received postoperative anti-tubercular therapy （ATT）, and did not have recur-rence with follow-up for 2 year. Conclusion BTB is rare and may be easily misdiagnosed, and examinations of pathology and microbiology are the preferred diagnostic methods.

关 键 词：结核 胆 黄疸 误诊 恶性肿瘤 

分 类 号：R524[医药卫生—内科学]