肝结核瘤的诊治探讨

Diagnosis and treatment of hepatic tuberculoma

目的探讨肝结核瘤的诊断与外科治疗措施。方法报告１９８０年１月～１９９３年１２月施行的肝切除术患者３４３例，其中术后经病理证实为肝结核瘤者８例。对该８例患者的诊断和治疗措施进行综合分析。结果８例中５例误诊为肝脏肿瘤，仅３例确诊。所有患者均行手术治疗，随访７例４年均无复发。结论对有结核病史的肝脏占位患者应高度怀疑为肝结核瘤；Ｂ超或ＣＴ导向下的肝穿刺活组织检查能明确诊断；治疗方式为施行肿瘤所在区域的肝段切除或局灶性切除，术后应用抗结核药物治疗以巩固疗效。

Objective To explore the appropriate diagnosis and treatment for hepatic tuberculoma.Method Eight cases with hepatic tuberculoma confirmed pathologically were reported and analyzed.Resulits Five of the eight cases were misdiagnosed as other types of hepatic tumor,and only 3 cases correctly diagnosed preoperatively.All cases underwent segmentectomy or local resection,and no relapse was found after four year follow up in seven cases.Conclusions The cases with hepatic occupying space lesions who had tuberculosis history should be suspected of being hepatic tuberculoma;The aspiration liver biopsy guided by B mode ultrasound and CT scan can provide correct diagnosis;The segmentectomy and local resection are effective and practicable for treatment of hepatic tuberculoma,and the antituberculosis drugs should be administrated postoperatively so as to strengthen the therapeutic effect.