假肿瘤样肝结核13例诊治分析

Diagnosis and treatment of 13 cases of pseudotumoral hepatic tuberculosis

目的:探讨假肿瘤样肝结核的诊治特点。方法:对我院1980年1月至2002年12月收治的13例假肿瘤样肝结核患者的临床表现、影像学特点、诊治情况等进行分析。结果:1例术前经B超引导穿刺诊断为肝结核,所有患者均接受肝切除术,术后正规抗结核治疗,随访2年,未见结核复发。结论:假肿瘤样肝结核术前误诊率高,对于有结核病史,有发热、右上腹不适、肝脏肿大、消瘦等表现,无乙肝肝硬化,影像学检查发现孤立肝脏占位病变伴钙化,肿大而边缘强化的淋巴结等,血清甲胎蛋白阴性,应注意假肿瘤样肝结核的可能。手术和术后的抗结核治疗是一种有效的治疗手段。

Objective： To study the diagnostic and therapeutic features of pseudotumoral hepatic tuberculosis. Methods： 13 cases of pseudotumoral hepatic tuberculosis were analyzed from the aspect of clinical manifestation, diagnosis and treatment. Results： Only one case was diagnosed as hepatic tuberculosis preoperatively by US-guided aspiration. All the patients accepted hepatectemy and the diagnosis were confirmed by postoperative pathology. Postoperative antituberculosis therapy had been performed for 9-12 months. All patients were followed up at least two years without recurrence. Conclusion： The patients with tumor-like hepatic nodule and the following clinical signs should be suspected as pseudotumoral hepatic tuberculosis, such as tuberculosis history, fever, discomfort at right upper quadrant, weight loss, without liver cirrhosis, AFP（-）, calcify in hepatic mass, lymphadenopathy with marginal enhancement in CT scan. Hepatic resection and antituberculosis therapy are effective treatments.