食管结核误诊分析并文献复习

Misdiagnosis Analysis and Literature Review for Esophageal Tuberculosis

目的探讨食管结核发病机制、临床特点、诊治要点及误诊原因、防范措施。方法对郑州市第六人民医院近期收治的1例曾误诊的食管结核的临床资料进行回顾分析,并复习相关文献。结果患者因吞咽痛2个月,加重伴午后低热、盗汗10 d就诊。曾在当地医院就诊,考虑冠心病,但心电图检查未发现异常,后到某省级医院就诊,行胃镜及活组织病理检查诊断食管溃疡,不除外结核?内镜下活组织病理切片经另一省级医院病理科医师会诊,诊断不能除外猫抓病样肉芽肿性炎。1个月前曾来我院就诊,经相关检查诊断为反流性食管炎、食管溃疡?予相应治疗,病情加重。近10 d患者出现午后低热、盗汗,再次来我院就诊。经综合分析病情考虑结核病,经4周试验性四联抗结核治疗后,患者症状明显缓解出院。出院后继续1个月四联抗结核治疗,并行7个月二联抗结核治疗。完成6个月抗结核治疗时复查胃镜显示食管溃疡已经消失,仅遗留瘢痕。结论食管结核较为少见,且缺乏特异性临床表现及诊断措施,易误诊。为此临床医师要全面详细收集患者病史,掌握食管结核临床特点和正确诊疗方法,以避免误诊误治。

Objective To investigate pathogenesis,clinical features,key points of diagnosis and treatment,misdiagnosed reasons and prevention methods for esophageal tuberculosis. Methods Clinical data of one patient misdiagnosed as having esophageal tuberculosis in recent years was retrospectively analyzed,and related literature was also reviewed. Results The patient visited the doctor for odynophagia for 2 months,aggravated condition associated by afternoon low-grade fever and night sweats for 10 days. Coronary heart disease was suspected when the patient had visited a local hospital,but no abnormal condition was found by electrocardiogram（ ECG） examination. Afterwards,esophageal ulcer was diagnosed in a provincial hospital after gastroscope and biopsy,and esophageal tuberculosis could not be excluded. After pathology consultation by another provincial hospital,granulomatous inflammation caused by cat-scratch disease could not be excluded. One month ago,the patient visited our hospital and was diagnosed as having reflux esophagitis and esophageal ulcer after related medical examinations. The symptoms aggravated after corresponding treatment,and the patient visited our hospital again for afternoon lowergrade fever and night sweats for 10 days. Esophageal tuberculosis was highly suspected after comprehensive evaluation. The symptoms were obviously alleviated,and the patient was discharged after experimental anti-tuberculosis four-drugs treatment for 4 weeks. Two-drugs anti-tuberculosis treatment for 7 months was performed after four-drugs anti-tuberculosis treatment for 1month was completed after discharging. Endoscopy rechecking after ending 6 months of anti-tuberculosis treatment showed that only scarring was found without the ulcer. Conclusion Esophageal tuberculosis is rare with nonspecific clinic manifestation,and therefore it is easily misdiagnosed. So clinicians should collect patients＇ medical history in great detail,learn clinical characteristics and proper way of diagnosis and treatment to avoid misdiagnosis and mistreatment.