脾结核12例临床诊治体会

目的 总结脾结核的临床诊断和治疗体会。方法回顾性分析广西医科大学第一附属医院肝胆外科1995—2005年收治12例脾结核病人的临床资料。主要临床表现为长期发热、纳差、消瘦、左上腹痛。脾肿大伴贫血。B超、CT检查均提示脾肿大，其中11例示脾内占位病变。6例手术治疗，术后均予正规的抗结核治疗，另6例保守治疗。结果全部病人均恢复良好，能正常生活、工作。结论脾肿大伴发热、纳差、消瘦、左上腹痛、贫血等时，应考虑该病可能，尤其是合并脾外结核者。影像学检查对诊断有价值但无特异性。对孤立性或某些多发性脾结核，不能排除脾脏恶性肿瘤时，手术既能明确诊断，又能达到治疗目的。无论手术与否，均应给予正规抗结核治疗。

Clinical experience in diagnosis and treatment of 12 cases of splenic tuberculosis

Objective To explore methods for diagnosis and treatment of splenic tuberculosis.Methods The clinical data of 12 patients with splenic tuberculosis treated between 1995 and 2005 in the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively.Twelve patients (7 males and 5 females) were enrolled in the study.The main clinical features included long-term fever,anepithymia,weight loss,pain of left upper quadrant,splenomegalia,and anemia.Splenomegalia was discovered by abdominal ultrasonography and CT.Six of 12 underwent splenectomy and received anti-tuberculosis treatment after surgery,and the rest were given normal anti-tuberculosis therapy.Results The recovery of all 12 cases was satisfactory.Conclusion Splenomegalia and long-term fever,anepithymia,weight loss,pain of left upper quadrant,and anemia are significant for diagnosis of splenic tuberculosis,especially with other organic tuberculosis simultaneous.Image examinations have value in diagnosis of splenic tuberculosis but no specificity.Surgery is adopted as the available means of diagnosis and treatment for some diagnosis unknown splenic tuberculosis.Anti-tuberculosis treatment is the main means of treatment and indispensable for splenic tuberculosis.