胆胰部位结核6例分析

Six cases of pancreatobiliary and peripancreatobiliary tuberculosis

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。

Objectiye To determine the clinical, imaging and pathologic characteristics of pan creatobiliary and peripancreatobiliary 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 tuberculosis 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 imaging manifestations included peripancreatobiliary mass in peripancreatobiliary lymph nodes tuberculosis, 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 examination. 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 pancreatobiliary 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. Pancreatobiliary and peripancreatobiliary tuberculosis can be effectively cured by effective bile duct drainage and anti-tubercular drugs.