误诊为肿瘤的腹腔结核

目的 探讨腹腔结核（TB)的临床病理特征和诊断。方法 对1962－1997年间,临床上被误诊为肿瘤（其中31例被误诊为恶性肿瘤）,术后经病理检查确诊的45例腹腔TB作回顾性研究。结果 腹腔TB以青年人（≤40岁者29例,64％）和女性（28例,62％）多见。临床主要表现为腹部包块37例（82％）和腹痛30例（67％）,其中伴发热17例（38％）、腹胀、便秘或腹泻15例（33％）、体重减轻14例（29％）。手术所见：病变均为肠、腹膜和淋巴结多处受累,病变处有大小不等的包块和结节,酷似癌。镜检：增生型25例,干酪样坏死型14例,混合型6例。结论 腹腔TB的临床诊断与癌的鉴别困难。要提高对腹腔TB临床病理特征的认识,对经各种检查难以确诊的病例,作剖腹探查活检是必要的,以免造成误诊误治。

Abdominal tuberculosis misdiagnosed as tumor

Objective To evaluate the clinical and pathological features of abdominal tuberculosis (TB) in order to establish correct diagnosis. Methods Forty five cases of abdominal TB, which were clinically misdiagnosed as tumor (misdiagnosed as malignant tumor in 31 cases) between 1962 and 1997 were reviewed The diagnosis was confirmed histopathologically after the operation. Results Most of the patients with abdominal TB were young in age (<40 years in 29 cases, 64%) and females (28 cases, 62%) The main clinical manifestations were abdominal mass (37 cases, 82%), abdominal pain (30 cases, 67%), fever (17 cases, 38%), abdominal distension, constipation or diarrhea (15 cases, 33%) and weight loss (14 cases, 29%) The finding during operation showed multiple massive lesions involving intestine, peritoneum and lymph nodes in all the cases, which mimicked those with abdominal tumor Under microscopy, proliferative type of lesions were found in 29 cases, caseous necrosis type in 11 cases and mixed type in 5 cases Conclusions It is showed that the clinical manifestations of abdominal TB mimic those in abdominal tumor It is recommended that clinicians should improve understanding of clinical and pathological features of the abdominal TB and that exploratory laparotomy biopsy should be performed on those with suspected abdominal TB