Pancreatic tuberculosis misdiagnosed for surgical treatment:clinical analysis of 3 cases and literature review

The incidence rate of pancreatic tuberculosis(PT)is low,and it is difficult to distinguish from pancreatic malignant tumor before operation.We present 3 patients diagnosed after surgical treatment.All 3 cases involved female patients who were admitted due to primary manifestation of abdominal pain.These patients did not exhibit symptoms such as jaundice or back pain,and their tumor markers were within normal range.The surgical interventions employed included partial resection of the tumor in 1 case,mass resection in another,and pancreaticoduodenectomy in the third.Preoperative puncture biopsy is essential for diagnosing PT,and it should be actively conducted on patients with suspected cases.We summarize several common manifestations of PT to find the possibility of tuberculosis during preoperative evaluation and avoid misdiagnosis and unnecessary surgery.

出现声音嘶哑的18例Chiari畸形的诊治分析

目的探讨出现声音嘶哑等耳鼻咽喉症状的Chiari畸形患者的诊治情况。方法回顾性收集青岛大学附属医院1989年1月至2020年1月收治的18例出现声音嘶哑的Chiari畸形患者的临床资料,其中男5例,女13例,年龄3~71岁,中位年龄52岁。所有患者均接受颅脑MRI和喉镜检查,总结患者症状和首诊科室、确诊时间、总病程、声音嘶哑病程、诊断治疗情况和术后恢复时间。随访3~16年,中位随访6.5年。采用描述性方法进行分析。结果18例患者首次就诊科室包括神经科(9例)、耳鼻咽喉头颈外科(5例)、儿科(2例)、骨科(1例)、呼吸科(1例),除神经科7例初诊时明确诊断之外,就诊于其余科室的11例患者均未及时确诊。18例Chiari畸形患者确诊时病程2个月~5年,其中声音嘶哑症状出现20 d~5年。确诊后,9例患者接受后颅窝减压手术治疗,其中1例同时行脊髓空洞引流术,术后8例患者症状明显改善,症状改善时间为1~30 d;9例患者选择药物保守治疗,其中8例声嘶症状无改善,6例病情进展加重。结论后颅窝减压手术是治疗Chiari畸形的有效方式,患者预后较好。及时诊断和治疗可以改善患者预后。