肝结核20例临床分析

目的 探讨肝结核的诊断和治疗措施.方法 对20例肝结核患者的临床资料进行回顾性分析.结果 20例患者中表现为发热、盗汗、纳差、腹痛、腹胀和腹泻分别为10例(50%)、4例(20%)、12例(60%)、8例(40%)、12例(60%)、4例(20%)和无症状3例(15%).腹部B超及CT检查发现肝内占位性病变15例,肝内有钙化灶2例,肝脏肿大3例.手术及病理诊断肝结核15例,2例因肝内有钙化灶诊断为肝结核,另3例采用诊断性抗结核治疗有效诊断为肝结核.20例患者中有16例合并肝外结核.所有患者均经过1.5年以上的抗结核治疗,经随访预后良好.结论 肝结核患者的临床和影像学表现多样,且无特异性,误诊误治率高.确诊的主要手段是肝脏病理学检查及诊断性治疗,系统的抗结核治疗及选择性手术治疗是肝结核患者的有效治疗手段.

Clinical analysis of 20 cases with hepatic tuberculosis

Objective To summarize the clinical features,diagnosis and treatment of hepatic tuberculosis.Methods The clinical data of 20 cases with hepatic tuberculosis were retrospectively analyzed.Results Among the 20 patients,loss of appetite and abdominal distension were found in 12 cases,fever in 10 cases,abdominal pain in 8 cases,night sweat and diarrhea in 4 cases,no abnormalities in 3 cases.Abdominal CT and ultrasonic examinations revealed focal liver space occupying lesions in 15 cases,focal calcifications in 2 cases,and hepatomegaly in 3 cases.15 cases of hepatic tuberculosis were determined by operative pathology,2 cases by local liver calcifications,and 3 cases by diagnostic therapy.Among the 20 patients,16 cases had extrahepatic tuberculosis.All the patients received anti-tuberculosis chemotherapy for over 1.5 years,and recovered well.Conclusions The clinical characteristics and photography of hepatic tuberculosis are variable,and have nonspecific manifestations.So the erroneous diagnostic rates are high.Now the diagnosis of hepatic tuberculosis is mainly by pathology and therapeutic trial.Systemic anti-tuberculous therapy and selective surgical treatment are the main effective treatments.