原发性肝结核外科治疗体会  

Experience in the surgical treatment of primary hepatic tuberculosis

作　　者：龙新[1] 张磊[1] 赵健萍 程琪[1] 朱鹏[1] 张必翔[1] 陈孝平[1] Long Xin;Zhang Lei;Zhao Jianping;Cheng Qi;Zhu Peng;Zhang Bixiang;Chen Xiaoping(Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心肝胆胰疾病湖北省重点实验室,湖北武汉430030

出　　处：《腹部外科》2020年第4期278-281,共4页Journal of Abdominal Surgery

基　　金：国家自然基金青年基金项目(81803175);湖北陈孝平科技发展基金会(CXPJJH11900001-2019345)。

摘　　要：目的探讨原发性肝结核的临床特点和外科治疗方式,总结临床诊治经验。方法回顾性分析2012年至2017年华中科技大学同济医学院附属同济医院收治的11例原发性肝结核病人的临床特点、临床处理和随访。结果11例中男性7例,女性4例,年龄18~66岁,平均年龄42.7岁。均无结核病史,最常见症状为腹痛(45%),实验室检查无明显异常。病灶超声表现为低回声,内部回声不均匀,CT表现为低密度伴不同程度强化,MRI混杂信号。术前诊断:肝细胞癌2例,肝内胆管癌1例,肝门部肿瘤2例,肝良性肿瘤3例,肝脓肿2例,其中1例肝结核可能,肝包虫病或肝肿瘤1例,误诊率高达91%。手术方式包括肝部分切除5例,剖腹探查+肝组织活检术2例,肝脓肿切开引流+脓肿壁活检术2例,经皮肝组织活检术2例。术后常规抗结核治疗,随访至今均未见结核复发迹象。结论原发性肝结核临床表现不一,极易误诊,外科干预可以切除病灶和明确诊断,术后常规抗结核治疗可以有效控制结核。Objective To investigate the clinical characteristics and surgical treatment of primary hepatic tuberculosis,and summarize the experience of clinical diagnosis and treatment.Methods The clinical characteristics,clinical management and follow-up of 11 patients with primary liver tuberculosis admitted to Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from 2012 to 2017 were retrospectively analyzed.Results There were 7 males and 4 females,aged 18-66 years,with a mean age of 42.7 years.None of them had a history of tuberculosis.the most common symptom was abdominal pain(45%),and laboratory tests were unremarkable.The lesion showed hypoechogenicity on ultrasound,heterogeneous internal echoes,hypodensity with varying degrees of enhancement on CT,and mixed signals on MRI.The preoperative diagnosis was hepatocellular carcinoma(2 cases),cholangiocarcinoma(1 case),hilar tumor(2 cases),benign liver tumor(3 cases),liver abscess(2 cases),of which 1 case of hepatic tuberculosis,hepatic echinococcosis or liver tumor(1 case),with a misdiagnosis rate as high as 91%.Surgical methods included partial hepatectomy in 5 cases,laparotomy+liver biopsy in 2 cases,incision and drainage of liver abscess+abscess wall biopsy in 2 cases,and liver biopsy in 2 cases.Postoperative conventional anti-TB treatment,follow-up to date showed no signs of tuberculosis recurrence.Conclusion The clinical manifestations of primary hepatic tuberculosis are different,and it is easy to be misdiagnosed.Surgical intervention can remove the lesion and confirm the diagnosis.Postoperative routine anti-tuberculosis treatment can effectively control tuberculosis.

关 键 词：原发性肝结核 肝切除 肝脓肿穿刺引流 

分 类 号：R657.3[医药卫生—外科学]