胆胰部位结核6例分析

目的 探讨胆胰部位结核的临床和病理特征,提高对该病的诊治水平.方法 回顾性分析复旦大学附属中山医院经手术证实的6例胆胰部位结核误诊为恶性肿瘤病例的临床资料.病人均为中青年,临床表现为黄疸、发热及腹痛.术前影像学检查提示局限性胆管狭窄伴近端肝内外胆管扩张;胆胰周围淋巴结结核病人还表现为胆胰周围实质性占位;胰腺结核病人可见胰头占位伴胰周淋巴结肿大;胆管结核病人胆管周围及十二指肠圈软组织影增多.6例术前均误诊癌肿而行手术探查由病理确诊,术后均予抗结核治疗.结果 经随访所有病例胆胰周围肿块明显缩小,黄疸、发热等临床症状消失.结论 胆胰部位结核与胆胰恶性肿瘤具有相似的临床表现和影像学特征,在术前难以鉴别,常需术中或术后病理检查确诊.经手术或内镜进行有效的支撑和引流胆道,术后积极的抗结核治疗是治愈胆胰结核的关键.

Six cases of pancreatobiliary and peripancreatobiliary tuberculosis

Objective To determine the clinical, imaging and pathologic characteristics of pan-creatobiliary and peripanereatobiliary tuberculosis. Methods The clinical data of 6 patients (4 male, 2 female; mean age 41.3 yrs, range 24-54 yrs) with pancreatobiliary and peripancreatobiliary tuberculo-sis treated in Zhongshan Hospital of Fudan University were analyzed retrospectively. Main clinical presentations were abdominal pain, fever and jaundice. Chest X-rays revealed TB in only one patient. Imaging findings showed limited biliary stricture with dilation of the proximal bile duct and other ima-ging manifestations included peripancreatobiliary mass in peripancreatobiliary lymph nodes tuberculo-sis, mass in the head of pancreas with enlarged peripancreatic lymph nodes in pancreatic tuberculosis, abnormal soft tissues around bile duct and duodenum in bile duct tuberculosis. All the 6 cases were misdiagnosed as malignancies before laparotomy. Tuberculosis was confirmed by pathological examina-tion. Therapeutic approaches included bile duct drainage and anti-tubercular drugs for 6-12 months. Results All the 6 were followed up for 3 months to 12 years. No recurrence of tuberculosis was found in the pancreatobiliary and peripancreatobiliary region. Conclusion The manifestations of pancreato-biliary and peripancreatobiliary tuberculosis are mimicking with those of malignancies. The diagnosis of tuberculosis is usually not suspected prior to laparotomy. Tuberculosis should be considered as a differential diagnosis in younger patients with pancreaticobiliary and peripancreaticobiliary mass. Pan-creatobiliary and peripancreatobiliary tuberculosis can be effectively cured by effective bile duct drain-age and anti-tubercular drugs.