胸腺结核二例并文献复习

Tuberculosis of the thymus-2 cases report and review of the literature

通过总结山东省胸科医院收治的1例胸腺结核+胸腺瘤和1例肺结核+胸腺结核+胸膜结核瘤患者的临床表现、辅助检查[包括胸部CT、腹部B超、结核菌素试验、结核感染T细胞斑点试验(T-SPOT.TB)等]、诊治过程及随访情况等临床资料,以及结合1958—2016年共21篇国内外相关文献,共计24例患者对胸腺结核的临床特点、诊断和治疗情况进行回顾性分析。认为胸腺结核极其罕见,胸部CT等影像学检查虽可提示病变,但不能确诊;细菌学、组织学和病原学检查可以明确诊断,故对纵隔肿物患者术前应进行病因学检查,尤其是结核病相关检查。对于疑诊为结核病的患者应术前给予诊断性抗结核药物治疗,并在符合手术指征后行手术切除病灶,术后继续坚持规范抗结核药物治疗可望治愈。

In the study, we reported two cases who diagnosed as thymic tuberculosis (TB), their clinical characteristics, such as symptoms, image findings, tuberculin skin test, T-SPOT.TB, treatment and outcome, were summarized and evaluated, retrospectively. Moreover, between 1958 and 2016, patients with thymic TB (n=24) reported by others (21 studies) were also analyzed. Overall, thymic TB is extremely rare. Although routine chest CT and other image findings suggest the disease, it couldn’t confirm it. Nevertheless, bacteriological and histological examinations can make a definite diagnosis, so in order to identify the cause of mediastinal mass, these assays should be considered in practice. In addition, for management of suspected thymic TB patients, diagnostic treatment should be prescribed timely, and the lesions should be treated surgically when indications arise. Meanwhile, it is recommended to follow standard anti-TB treatment for a better outcome.