胰腺结核误诊为胰腺肿瘤临床分析并文献复习  

Clinical Analysis of Pancreatic Tuberculosis Misdiagnosed as Pancreatic Tumor and Literature Review

作　　者：刘莉 房栋 张小英 董晓娟 张宁 王科文 LIU Li;FANG Dong;ZHANG Xiaoying;DONG Xiaojuan;ZHANG Ning;WANG Kewen(Department of Tuberculosis,Shaanxi Provincial Tuberculosis Prevention and Control Hospital,Xi'an 710100,China;Department of Respiratory Medicine,People's Hospital of Shangzhou District,Shangluo,Shaanxi 726000,China;Department of Tuberculosis,the 987th Hospital of Joint Logistic Support Force of the PLA,Baoji,Shaanxi 721006,China)

机构地区：[1]陕西省结核病防治院结核内科,西安710100 [2]商洛市商州区人民医院呼吸内科,陕西商洛726000 [3]中国人民解放军联勤保障部队第九八七医院结核科,陕西宝鸡721006

出　　处：《临床误诊误治》2025年第7期8-13,共6页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省卫生健康委员会卫生健康科研项目(2018D046)。

摘　　要：目的探讨胰腺结核误诊为胰腺肿瘤的原因及防范措施。方法回顾性分析2021年1月至2023年1月被误诊的2例胰腺结核患者的临床资料,并复习相关文献。结果1例因反复上腹痛20余天就诊,行腹部超声、上腹部增强CT和磁共振成像检查,初步诊断为胰腺肿瘤。1例因反复右上腹痛3月余,加重1周就诊,行上腹部增强CT检查,初步诊断为胰腺肿瘤。2例均具有手术指征,行胰十二指肠切除术。1例术中探查发现胰头处有肿块,快速冰冻病理显示肉芽肿及坏死,常规病理提示结核;1例术中发现胰腺实质内干酪样坏死及周围米粒样结节,快速冷冻病理提示结核,术后查结核T细胞斑点试验阳性。2例均确诊为胰腺结核,误诊时间分别为25 d及104 d。2例术后均接受系统性抗结核治疗,病情好转出院。随访1年,均治愈。结论胰腺结核临床上较为罕见,临床表现及影像学表现缺乏特异性,容易误诊。仔细询问患者结核相关病史,并在术前利用超声内镜引导细针穿刺吸取活检术明确诊断,可以避免误诊误治的发生。Objective To investigate the causes and preventive measures of pancreatic tuberculosis misdiagnosed as pancreatic tumors.Methods The clinical data of 2 patients with misdiagnosed pancreatic tuberculosis from January 2021 to January 2023 were retrospectively analyzed,and the relevant literature was reviewed.Results One patient presented with re⁃current upper abdominal pain for more than 20 d.Abdominal ultrasound,upper abdominal enhanced CT and magnetic reso⁃nance imaging were performed,and the initial diagnosis was pancreatic tumor.One patient presented with recurrent right up⁃per abdominal pain for more than 3 months,which was aggravated for 1 week.Upper abdominal enhanced CT examination was performed,and the initial diagnosis was pancreatic tumor.Both patients had surgical indications and underwent pancreaticodu⁃odenectomy.In 1 patient,a mass was found in the pancreatic head during intraoperative exploration,rapid frozen pathology showed granuloma and necrosis,and routine pathology suggested tuberculosis.Caseous necrosis and rice⁃like nodules in the pancreatic parenchyma were found in 1 patient during operation,rapid frozen pathology indicated tuberculosis,and the T⁃spot test for tuberculosis was positive after operation.Both patients were diagnosed with pancreatic tuberculosis,and the misdiagno⁃sis lasted 25 d and 104 d,respectively.Both patients received systemic anti⁃tuberculosis treatment and were discharged after the condition was improved.After 1 year of follow⁃up,all patients were cured.Conclusion Pancreatic tuberculosis is rare in clinical practice,and its clinical and imaging manifestations are lack of specificity,which is more likely to be misdiagnosed.Careful inquiry about the patient's history of tuberculosis and the use of endoscopic ultrasound⁃guided fine needle aspiration bi⁃opsy before surgery can be used to confirm the diagnosis,and avoid the occurrence of misdiagnosis and mistreatment.

关 键 词：胰腺结核 误诊 胰腺肿瘤 腹痛 影像学 鉴别诊断 超声内镜 细针穿刺吸取活检术 

分 类 号：R525[医药卫生—内科学]