肝胆结核误诊为肝门部胆管癌

A Case Report of Hepatobiliary Tuberculos Misdiagnosed as Hilar Cholangiocarcinoma

目的总结肝胆结核的临床特点及诊治要点,减少误诊误治。方法对误诊为肝门部胆管癌的肝胆结核1例的临床资料进行回顾性分析。结果本例因乏力、食欲缺乏15 d伴皮肤、巩膜黄染4 d入院。曾就诊于当地医院,诊断为肝门部胆管癌,入我院后查肝功能、肿瘤标志物及行腹部增强CT检查,仍考虑肝门部胆管癌,行肝门部胆管癌根治术。术后病理诊断为肝胆结核,予正规抗结核治疗,病情好转出院。后电话随访3年,复查上腹部CT及肝功能均正常。结论肝胆结核临床少见,术前充分检查并综合分析,术中及时行冷冻活检是减少误诊误治的关键。

Objective To summarize clinical characteristics and diagnosis of hepatobiliary tuberculosis in order to avoid misdiagnosis and mistreatment. Methods Clinical data of a patient with hepatobiliary tuberculosis misdiagnosed as hilar cholangiocarcinoma was retrospectively analyzed. Results The patient was admitted for 15 d complicated with jaundice for4 d. The patient visited a local hospital,and was diagnosed as having hepatic bile duct carcinoma of the portal vein. Then the patient was admitted to our hospital to check liver function,tumor markers and abdominal enhanced CT,and hilar cholangiocarcinoma was diagnosed,and the radical surgery of hilar cholangiocarcinoma was performed,and then hepatic and billiard tuberculosis was confirmed by postoperative pathological result. The patient received postoperative anti-tubercular therapy and discharged from hospital after condition was improved. The patient was followed up for 3 years,and enhanced CT and liver function showed no abnormal. Conclusion Hepatobiliary tuberculosis is rare. Relevant preoperative examination,comprehensive analysis before operation and timely intraoperative frozen section diagnosis are important in terms of preventing misdiagnosis and mistreatment.