肝结核1例报道(附158例文献资料分析)

Hepatic tuberculosis:a report of one case and literature data analysis of 158 cases

目的探讨肝结核的临床和影像学表现及其实验室检查、诊断、治疗和预后,提高对肝结核的认识。方法报道笔者收治的肝结核病例1例,同时检索2000~2015年期间的国内文献,收集资料相对完整的肝结核病例158例,对159肝结核病例的临床表现、影像学检查、诊断方法及预后进行综合分析。结果①159例中以男性患者居多,男女比例约为2:1;症状以发热(68.55%),肝区不适(43.40%)及食欲不振、乏力(40.88%)多见。②实验室检查:血沉升高(71.76%)、肝功能异常(58.49%)、血红蛋白降低(52.83%)。③影像学诊断率:CT与B超检查的阳性率差异无统计学意义(P>0.05),而MRI检查的阳性率高于前两者,其差异有统计学意义(P<0.05)。④肝结核术前诊断率低,约为13.84%;误诊率较高,以误诊为肝癌最多见,确诊主要依靠病理学检查。⑤治疗上以内科药物治疗为主,效果较好。结论肝结核缺乏特异性临床表现,影像学表现多样,诊断率低,易误诊。确诊依靠病理组织学检查。治疗上首选药物治疗,预后较好。

Objective To investigate the clinical and imaging manifestations, laboratory examination, diagnosis, treatment and prognosis of hepatic tuberculosis, and improve the understanding of hepatic tuberculosis. Methods One case of hepatic tuberculosis that treated by author was reported, at the same time, the domestic literatures were retrieved from 2000 to 2015, 158 cases of hepatic tuberculosis were collected, and the clinical manifestations, imaging examination, diagnosis and prognosis of 159 cases were analyzed. Results ①In 159 cases, male patients were in the majority, male and female ratio was about 2：1. Symptom with fever （68.55%）, liver discomfort （43.40%）, loss of appetite and fatigue （40.88%） were the main performance. ②Results of laboratory examination： erythrocyte sedimentation rate increased （71.76%）, abnormal liver function （58.49%）, and lower hemoglobin （52.83%）. ③The comparation of imaging diagnosis： the positive rates of CT and B-ultrasound were no significant difference （P〉0.05）, there existed significantly difference between MRI, B-ultrasound and CT, MRI had a higher positive rate （P〈0.05）. ④The preoperative diagnosis rate of hepatic tuberculosis about 13.84%, was low. The misdiagnosis rate was high, during which liver cancer were the most common misdiagnosed. Diagnosis mainly depends on pathological examination. ⑤Medical treatment was the main treatment, and it’s effect was good. Conclusions Hepatic tuberculosis lacked specific clinical manifestations, and the imaging features of various, the diagnostic rate of hepatic tuberculosis was low, and the misdiagnosis rate was high. In order to definite it, histopathological examination is necessary. The first choice of treatment is drug therapy, which is good.