食管结核误诊为食管癌临床分析  

Clinical Analysis of Misdiagnosis of Esophageal Tuberculosis as Esophageal Cancer

作　　者：东艳蕊 董玉荣 杨淑芹[2] 郜攀峰[1] 王静[1] 李宽红 邵翠翠 DONG Yan-rui;DONG Yu-rong;YANG Shu-qin;GAO Pan-feng;WANG Jing;LI Kuan-hong;SHAO Cui-cui(Department of Nephrology and Hematology,the People's Hospital of Nanpi,Nanpi,Hebei 061500,China;Department of Renal Endocrinology,the People's Hospital of Nanpi,Nanpi,Hebei 061500,China)

机构地区：[1]南皮县人民医院消化血液科,河北南皮061500 [2]南皮县人民医院肾内分泌科,河北南皮061500

出　　处：《临床误诊误治》2020年第3期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局科研计划项目(2019314)。

摘　　要：目的分析食管结核的临床特点、误诊原因及防范措施。方法回顾性分析误诊为食管癌的食管结核2例的临床资料。结果1例因吞咽困难2个月,进行性加重伴持续性胸骨后疼痛1月余就诊,院外多次行胃镜及病理检查均提示食管癌可能性大,入院后经胃镜、病理检查及实验室检查结果确诊食管结核,给予三联抗结核治疗,症状明显好转。1例因进行性吞咽困难伴乏力、消瘦5个月就诊,两次胃镜及活检均考虑食管癌,择期行手术治疗,术后病理检查提示食管结核,给予三联抗结核治疗,病情明显好转。结论食管结核临床少见,部分患者无结核中毒症状,且临床表现无特异性,极易误诊为食管癌,提示临床应加强对本病的认识,多次多部位行病理检查,必要时行诊断性抗结核治疗,可一定程度避免误诊的发生。Objective To analyze the clinical characteristics,causes of misdiagnosis and preventive measures of esophageal tuberculosis.Methods A retrospective analysis was performed on the clinical data of 2 cases of esophageal tuberculosis misdiagnosed as esophageal cancer in our hospital.Results One case presented with progressive dysphagia for two months and persistent post-sternal pain for more than one month.Multiple gastroscopy and pathological examinations in other hospitals suggested the possibility of esophageal cancer.After admission to our hospital,esophageal tuberculosis was confirmed by gastroscopy,pathological examination and laboratory examination.Triple anti-tuberculosis therapy was given and the sympoms were greatly ameliorated.One case presented with dysphagia,accompanied by fatigue and weight loss for 5 months.Esophageal cancer was considered by two gastroscopy and biopsy examinations.The selective operation was performed,and postoperative pathological examination indicated esophageal tuberculosis.After operation,triple anti-tuberculosis therapy was given,and the condition was improved significantly.Conclusion Esophageal tuberculosis is rare in clinical practice,and some patients have no symptoms of tuberculosis poisoning or specific clinical manifestations.Therefore,it is more likely to be misdiagnosed as esophageal cancer.It is suggested that we should strengthen the understanding of this disease in clinical practice,carry out multiple pathological examinations of various body parts and provide diagnostic anti-tuberculosis treatment when necessary,which can avoid misdiagnosis to some extent.

关 键 词：结核 食管 误诊 食管肿瘤 利福平 异烟肼 乙胺丁醇 结核菌素试验 

分 类 号：R523[医药卫生—内科学]