误诊为胰腺肿瘤行手术切除的胰腺结核6例临床分析

目的：探讨胰腺结核的诊断和治疗方法。方法：回顾分析近3年误诊为胰腺癌的6例胰腺结核病例。结果：6例病人中有结核病史2例。临床表现为腹痛1例，腹胀5例，体重减轻1例，便血1例。6例均经剖腹探查．病理学证实；其中4例获病灶切除。全部病例均经术后抗结核治疗。6例中出现肠瘘1例，顽固性腹泻2例，区域性门静脉高压、食管下段静脉曲张各1例。结论：胰腺结核易被误诊为胰腺肿瘤而手术，故对影像学检查证实胰腺有局限性、囊性病变伴病灶周围及后腹膜淋巴结肿大，且肿瘤指标正常者，应考虑胰腺结核可能。切除胰腺结核可能发生的并发症较为严重，手术治疗应慎重考虑。

Analysis of 6 cases of pancreatic tuberculosis misdiagnosed as pancreatic tumor and leading to surgery

Objective To investigate the diagnosis and treatment of pancreatic tuberculosis. Methods Six cases of pancreatic tuberculosis admitted before May 2009 were retrospectively analyzed. Results Two cases had a history of tuberculosis. Clinical menifestations： 1 case with epigastric pain, 5 cases with abdominal distension, 1 case with weight loss, and another with hematochezia. All 6 cases were confirmed by laparotomy and pathology. Four of them received resection. All patients received anti-tuberculous therapy. One patient presented enterocutaneous fistula, intractable diarrhea in 2 patients, extrabepatic portal hypertension in 1 case. Conclusions Pancreatic tuberculosis is often misdiagnosed as pancreatic tumors leading to surgery. Pancreatic tuberculosis should be considered when the patients present evidence of regional and cystic lesion accompanied by swollen retroperitoneal lymph nodes in imaging, especially when normal concentration of tumor markers is shown. Resection of pancreatic tuberculosis may cause serious complications, so surgery should be carefully considered.