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胰腺结核10例临床特征及其诊治

Diagnosis and treatment of pancreatic tuberculosis: experiences of 10 cases

摘要:

目的 分析胰腺结核的临床表现,提高对该病的认识及诊疗水平.方法 回顾1990-2017年收治的10例胰腺结核病例,分析其病史、诊疗过程及预后.结果 10例患者中,男7例,女3例,年龄28~71岁,中位年龄56岁;均存在不同程度的腹痛及消瘦(3~8 kg);7例腹部超声表现为胰腺低回声占位性病变;4例腹部CT以分隔较厚的囊实性占位性病变为主要表现;10例均未见胰管增宽;血红蛋白<12 g/L者6例;ESR>20 mm/1 h者7例;4例行结核菌素纯蛋白衍化物试验,仅1例强阳性;CA19-9异常升高3例,分别为39、126及89 IU/ml(参考值<27 IU/ml);3例行结核特异性T细胞酶联免疫斑点检测(T-SPOT.TB)检测,均为阳性.7例接受手术探查切取部分病灶组织,3例行超声引导下胰腺病灶穿刺活检;10例病理组织学均发现干酪样坏死及朗格汉斯细胞而确诊.除1例失访外,其余患者均接受6~12个月的抗结核治疗,随访时间1~5年,8例已获得痊愈,1例尚在随访中(症状明显缓解).结论 胰腺结核临床表现缺乏特异性,易与其他胰腺疾病混淆.对可疑病例行超声内镜引导下穿刺活检利于确诊.经及时、规范的抗结核治疗可痊愈,预后良好.

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abstracts:

Objectives To study the clinical characteristics of pancreatic tuberculosis,and therefore to improve the diagnosis and treatment of this disease.Methods The clinical data of 10 patients with pancreatic tuberculosis form 1990 to 2017 were reviewed,including clinical characteristics,laboratory tests and imaging features.Results The ten patients aged 28 to 71 (median 56) years.All of them presented varying degrees of abdominal pain and weight loss (3 to 8 kg).Hypo-echoic pancreatic masses were shown by abdominal ultra-sound in 7 cases,and cystic-solid masses with thick wall was shown by abdominal CT scan in 4 cases,but dilatation of the pancreatic duct was found in none of the 10 cases.Hemoglobin levels lower than 12 g/L were found in 6 cases,and ESR more than 20 mm/1 h was present in 7 cases.Four cases received PPD test,but only one was positive.CA19-9 was found to be higher than normal (27 IU/ml) in 3 cases (39.2 IU/ml,125.7 IU/ml,88.9 IU/ml respectively).Three cases received T-spot.TB tests,and all the results were positive.Seven cases received laparotomy,and the other 3 received endoscopic ultrasound-guided biopsy.Caseous necrosis and Langerhans cells were found in all the 10 cases.Nine patients were treated by 6 to 12 months' anti-tuberculosis therapies,and at 1-5 years' follow-up,8 were cured and 1 improved.Conclusions The manifestations of pancreatic tuberculosis were easy to be confused with other diseases,and therefore a comprehensive understanding of history and careful examinations were important for a correct diagnosis.Once the diagnosis was made,prompt standard anti-tuberculosis therapy could lead to a favorable outcome.

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作者: 徐力 [1] 谭海东 [1] 刘立国 [1] 刘笑雷 [1] 黄笳 [1] 司爽 [1] 周文颖 [1] 孙永亮 [1] 杨志英 [1]
期刊: 《中华结核和呼吸杂志》2019年42卷5期 357-360页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1001-0939.2019.05.008
发布时间: 2019-06-17
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