食管结核的诊断和外科治疗

Diagnosis and surgical treatment of esophageal tuberculosis

目的探讨食管结核的临床病理特征、诊断及外科治疗方法，减少误诊发生。方法回颐性分析11例患者的相关临床资料。结果术前诊断为食管结核2例；误诊9例，分别诊断为食管癌7例、食管平滑肌瘤2例。药物治疗2例，手术治疗9例，手术方式包括病灶段食管切除＋胃食管吻合术5例、淋巴结切除术2例、胃造瘘术1例，1例术中冰冻切片检查证实结核而未切除食管，术后无严重并发症发生。11例患者均经病理证实为食管结核，全部治愈，随访1～27年，症状均消失，结核无复发。结论食管结核属罕见良性疾病，临床无特异征象，与食管癌和食管良性肿瘤鉴别困难。术前明确诊断后采用药物保守治疗有效，如出现并发症则需外科干预，术后需抗结核治疗12～18个月，预后较好。

Objective To explore the clinical and pathologic characteristics,diagnosis,and surgical treatment of esophageal tuberculosis, and thereby reducing misdiagnosis rate. Methods The clinical data of 11 patients were retrospectively analyzed,and relative literature reviewed. Results There were 4 males, and 7 females with age ranged from 14 - 62 years（ mean 47.2 years old）. The clinical symptoms included dysphagia and retrosternal pain. Preoperatively 2 patients were diagnosed as esophageal tuberculosis. Seven patients were misdiagnosed as esophageal cancer, and 2 as esophageal leiomyoma. Nine patients were subjected to surgical treatment, and 2 took anti - tuberculosis medicine. The partial esophagectomy and esophageogastric anastomosis were performed on 5 patients,lymphadenectomy on 2 patients,and gastrostomy on 1 patient. One patient gave up the operation because intro - operative frozen section confirmed the diagnosis of esophageal tuberculosis. There were no serious complications after the operation. All of them were confirmed esophageal tuberculosis pathologically, cured. During a follow - up period of 1 - 27 years, all symptoms disappeared, and esophageal tuberculosis did not recur. Conclusion Esophageal tu- berculosis without typical clinical manifestation is a rare benign lesion of the esophagus,difficult to be differentiated from esophageal benign and malignant tumors. If the diagnosis can be defined preoperatively, anti - tuberculosis medication is effective. The surgical procedure will be given when the patients suffered from the complications of tuberculosis.