食管结核的内镜所见和临床表现分析

目的 :分析食管结核的胃镜所见和临床表现 ,提高对此病的认识。方法 :回顾分析中日友好医院 1 7年经胃镜检查发现的 1 0例食管结核 ,并复习国内 2 0 0 1年底以前文献 1 2 7例。结果 :1 0例患者中位年龄 3 5岁。病变位于食管中段 7例 ,上段 1例 ,下段 2例。主诉吞咽困难或吞咽阻挡感 5例 ,胸痛 2例 ,消瘦和腹部不适 3例。6例有既往结核病史或伴其它部位活动性结核。胃镜表现溃疡 6例 ,其中 1例伴窦道形成 ,狭窄 2例 ,隆起性病变 1例 ,假憩室 1例。 7例经内镜下活检病理确诊 ,3例抗结核治疗确诊。 1 0例均经抗结核治疗痊愈或缓解 ,无一例手术。结论 :食管结核约 70 %发生于食管中段 ,内镜下常表现为溃疡、狭窄和隆起 ,易误诊为食管癌和粘膜下肿瘤。内镜下活检结合抗结核试验治疗是诊断此病的有效方法。

Endoscopic and clinical characteristics of esophageal tuberculosis

Objective:To improve the understanding of the clinical characteristics and endoscopic features of esophageal tuberculosis. Methods:Ten cases of esophageal tuberculosis detected by endoscopy from 1984 to 2001 in our hospital and 127 additional cases from domestic literature were reviewed.Results:The median age of the ten patients (2 male and 8 female cases) was 35 years. The main presenting symptoms were dysphagia (5 cases), chest pain (2 cases), weight loss and abdominal pain (3 cases). Six patients had historical or active tuberculosis in other organs. The endoscopic appearances included ulcer (6 cases), stricture (2 cases), mass lesion (1 case), and pseudodiverticula (1 case). The middle esophagus was involved in 7 cases and the upper and lower third of the esophagus were affected in 1 and 2 cases, respectively.The diagnoses were confirmed by biopsies with pathology in 7 cases and by well response to antituberculous chemotherapy in 3 cases.Conclusion:Tuberculosis can affect the whole length of esophagus whereas about 70 percent of the lesions were in the middle part of the esophagus. The commonest abnormalities identified by endoscopy were ulceration with nodular mass lesion and constriction. Repeated endoscopic examination with biopsies and antituberculous therapy were suggested for establishing the diagnosis.