肝结核临床及影像分析

Clinical and imaging analysis of hepatic tuberculosis

目的了解肝结核的临床及影像学特点。方法回顾性分析2009年1月至2021年4月解放军总医院第五医学中心收治的20例肝结核患者的临床资料,对性别、年龄、主诉、体温、临床表现、实验室检查、影像学表现等进行总结归纳。结果20例肝结核患者的主要症状为发热、乏力、腹胀,所有患者中肿瘤标志物全呈阴性12例,CA199升高2例,CA125升高7例,CA153升高1例。14例显示为结节性或团块样病灶,2例表现为斑点或斑片样,病灶长径为0.60~18.00 cm,14例表现为病灶轻度环状或不均匀强化,10例可见分隔或分隔样强化,13例强化模式为延迟渐进性强化。12例患者可见腹腔淋巴结肿大,1例患者术后复查现巨大复发病灶。结论肝结核老年男性多见,以发热、乏力及腹胀为主,部分患者可有肿瘤标志物升高,影像学多表现为单发或多发的结节或斑片影,合并腹腔淋巴结肿大,增强扫描呈环状渐进性强化,部分可有相互融合和分隔样强化,影像学检查结合肝组织病理学检查是肝结核的主要确诊手段。

Objective To analyze the clinical and imaging features of 20 patients with hepatic tuberculosis(TB).Methods The clinical data and imaging materials of 20 patients with hepatic TB hospitalized in Fifth Medical Center of PLA General Hospital from January 2009 to April 2021 were analyzed retrospectively,the sex,age,main complaints,body temperature,clinical manifestations,laboratory examinations and imaging features were summarized.Results In 20 patients with liver TB,fever,fatigue and abdominal distension were the main symptoms.Laboratory examination showed that all tumor markers were negative in 12 cases,with 7 cases of CA125 increased,2 cases of CA199 increased,and 1 case of CA153 increased.14 cases of computed tomography(CT)or magnetic resonance(MR)showed nodules or mass-like lesions,2 cases showed spot or spot pattern,the focal length was between 0.60 cm to 18.10 cm,14 cases showed mild circular or uneven enhancement,irregular separation and division-like enhancement was seen in 10 cases,and 13 cases showed delay progressive enhancement.Increased abdominal lymph nodes were seen in 12 patients,and massive recurrent intrahepatic lesion was identified after surgery in 1 patient.Conclusion Hepatic TB is more common in middle-aged and elderly men.Fever,fatigue and abdominal distension were the main complaints.Some patients may havd elevated tumor markers.Most of the imaging findings were single or multiple nodules or patches,enlarged abdominal lymph nodes.Most enhancement scans show circular progressive enhancement,and some of them could have mutual fusion and separation enhancement,and some patients may recur.Imaging examination combined with liver pathological examination was the main diagnosis of hepatic TB.