协和医学杂志

2015, v.6(02) 119-123

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胰腺结核的临床特点及诊断要点
Clinical Features and Diagnosis of Pancreatic Tuberculosis

严雪敏;孙昊;杨爱明;
YAN Xue-min;SUN Hao;YANG Ai-ming;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的总结胰腺结核患者的一般临床特点及诊断要点,以提高对胰腺结核的认识。方法纳入1984年1月至2014年3月在北京协和医院确诊为胰腺结核的住院患者,回顾性分析其病例资料,对其临床表现、辅助检查、诊断等情况进行总结。结果研究期间确诊为胰腺结核的患者共10例,占同期确诊结核患者的0.12%(10/8689)。其中男5例,女5例,平均年龄53.1岁(31~70岁),65岁以下患者占80%。腹痛(60%)、纳差(60%)及体重下降(60%)是最常见的临床症状,发热(40%)、黄疸(10%)等症状较少见,未见盗汗。CT及PET/CT均未确诊胰腺结核。1例患者因结核菌素蛋白衍生物试验强阳性、发现肠结核,1例有颈部冷脓肿,临床综合考虑后诊断结核,抗痨治疗有效后验证临床诊断;1例行胫前结节活检证实为结核;1例经B超引导下胰腺结节穿刺证实为结核;6例行剖腹探查术,术后病理支持结核诊断。结论胰腺结核为罕见疾病,常因胰腺的局限性囊/实性占位而被误认为胰腺肿瘤,进而行手术治疗。病史及临床症状对诊断很重要,影像学有一定帮助,病理结果有确诊价值。对于年龄较轻、有感染征象、肿瘤标志物为阴性的胰腺占位、伴或不伴腹膜后淋巴结肿大的患者,要考虑胰腺结核可能,对不易鉴别的患者应积极行内镜引导下或B超引导下活检术,必要时行手术探查。
Objective To explore the clinical features and key points in diagnosis of pancreatic tuberculosis. Methods The clinical manifestations,auxiliary tests,and diagnosis of inpatients confirmed as pancreatic tuberculosis in Peking Union Medical College Hospital in the period from January 1984 to March 2014 were retrospectively analyzed. Results There were 10 cases of pancreatic tuberculosis diagnosed in the study period,accounting for 0. 12%( 10 /8689) of the total tuberculosis patients diagnosed at the same period. The 10 patients included 5 males and 5 females; aged 53. 1 years on average( 31- 70 years),with 80% below the age of 65.The most common symptoms were abdominal pain( 60%),anorexia( 60%) and weight loss( 60%). Fever( 40%) and jaundice( 10%) were less common,while night sweat was absent. CT and PET/CT failed to make the diagnosis of pancreatic tuberculosis. In one case,intestinal tuberculosis was found after positive result of purified protein derivative test. In another case with cold abscess at the neck,a clinical diagnosis of tuberculosis was made and later confirmed by response to anti-tuberculosis therapy. Tuberculosis was confirmed in one case by pretibial nodule autopsy result,another by ultrasound-guided pancreatic nodule needle autopsy. In the other 6 ca-ses,pathological examination after laparotomy confirmed the diagnosis of tuberculosis. Conclusions Pancreatic tuberculosis is rare. It may present as regional cystic or solid pancreatic masses and often be misdiagnosed as pancreatic tumors,leading to surgery. History and symptoms are the first key clues in diagnosis. Imaging is helpful,while confirmed diagnosis is made based on pathological results. For young patients with signs of infection,having pancreatic masses with negative tumor markers,with or without retroperitoneal enlarged lymph nodes,pancreatic tuberculosis should be considered. Endoscope- or ultrasound-guided biopsy is needed in patients hard to identify,and laparotomy may be used when necessary.

关键词(KeyWords): 胰腺结核;诊断;误诊;活检
pancreatic tuberculosis;diagnosis;misdiagnosis;biopsy

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作者(Author): 严雪敏;孙昊;杨爱明;
YAN Xue-min;SUN Hao;YANG Ai-ming;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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