肝结核5例诊治分析

目的]分析肝结核的临床表现、影像学特点及治疗措施,提出诊治对策,提高诊断能力.方法]回顾性 分析5例肝结核患者的病历资料,以期提高对肝结核的诊断及认识.结果]5例中,以脐周痛、发热为主要表现1例,以右上腹痛表现1例,以右下胸痛为主要表现1例,以肝功能损害为主要表现1例,以腹胀、多浆膜腔积液为主要表现1例；其中3例经病理及影像学检查确诊,另2例为临床诊断考虑肝结核,给予抗结核治疗有效.结论]肝结核可表现为腹痛、腹胀,也可无明显腹部症状,或仅有肝功能损害及表现为多浆膜病变；腹部CT表现为肝脏结节,增强后可强化,或有钙化表现；病理活检是金标准,表现为肉芽肿性炎.对于有肺结核病史,近期出现发热、纳差、腹痛、肝脏肿大伴触痛、血沉增高、肝功能异常尤其是γ-GT增高、贫血、甲胎蛋白正常,结合腹部CT及B超表现需考虑肝结核的可能.

Analysis on diagnosis and treatment of five cases of hepatictuberculosis

Objective]To analyze the characteristics of hepatictuberculosis in clinical manifestations,imaging and propose responsive treatment.Methods]The hospital medical records were collected in our hospital from August 1998 to June 2009,and the diagnosis and treatment of hepatictuberculosis were retrospectively analyzed.Results]Among the 5 confirmed cases,one mainly manifested as navel pain and fever,one as right upper quadrant pain,one as right chest pain,one as liver damage,and one as abdominal distention and polyserositis.Three cases were confirmed by pathology and imaging examinations,and the other 2 cases were considered as hepatic tuberculosis for the clinical diagnosis and antituberculous treatment were effective. Conclusion]Hepatic tuberculosis was rare in clinic practice.Tuberculosis could be primary in the liver,or secondary to pulmonary tuberculosis.Clinical manifestations may be abdominal pain and distension,or with no obvious abdominal symptoms,or only liver function damage and multiple serositis.Abdominal CT showed liver nodules,or with calcification.Biopsy was the gold diagnosis standard,showing granulomatous inflammation.For those with the history of pulmonary tuberculosis,recent anorexia,abdominal pain,fever and hepatomegaly with tenderness,increased erythrocyte sedimentation rate,abnormal liver function especially increased γ-GT,anemia,normal AFP,combined with abdominal CT and B ultrasound examinations should be considered as hepatic tuberculosis.