目的 總結(jié)膽管結(jié)核的臨床特點,以提高膽管結(jié)核的認識和診斷水平。
方法 分析1例膽管結(jié)核患者的臨床資料、診斷過程并復習文獻。
結(jié)果 根據(jù)患者病程中有盜汗、胸片中有陳舊性結(jié)核、術前結(jié)核感染T細胞斑點試驗(T-SPOT. TB)(+++)等信息,結(jié)合術中快速病理,明確診斷為膽管結(jié)核,行膽腸吻合術后,抗結(jié)核治療6個月后患者痊愈。
結(jié)論 膽管結(jié)核是一種罕見疾病,對于年輕患者患有占位性病變導致梗阻性黃疸、影像學中腫瘤特征不典型、患者來自結(jié)核高發(fā)區(qū)、有陳舊性結(jié)核病史、病程中有低熱盜汗等任一癥狀者,應該注意結(jié)核的鑒別診斷,首選T-SPOT. TB檢測或內(nèi)鏡引導下穿刺活檢,術中冰凍活檢是避免膽管結(jié)核患者過度醫(yī)療的最后一道防線。
引用本文: 戴洪山,嵇武,李良,王新波. 膽管結(jié)核致梗阻性黃疸1例并文獻復習. 中國普外基礎與臨床雜志, 2012, 19(11): 1232-1234. doi: 復制
版權(quán)信息: ?四川大學華西醫(yī)院華西期刊社《中國普外基礎與臨床雜志》版權(quán)所有,未經(jīng)授權(quán)不得轉(zhuǎn)載、改編
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- 1. Tosun S, Tosun A. Imaging of malignancy-suspected pancreatic involvement of extrapulmonary tuberculosis[J]. Turk J Gastroenterol, 2010, 21(1):54-59.
- 2. García JF. Extrapulmonary tuberculosis:situation in the new century[J]. Enferm Infecc Microbiol Clin, 2008, 26(9):537-539.
- 3. Brusko G, Melvin WS, Fromkes JJ, et al. Pancreatic tuberculosis[J]. Am Surg, 1995, 61(6):513-515.
- 4. Yeh TS, Chen NH, Jan YY, et al. Obstructive jaundice caused by biliary tuberculosis:spectrum of the diagnosis and management[J]. Gastrointest Endosc, 1999, 50(1):105-108.
- 5. Saluja SS, Ray S, Pal S, et al. Hepatobiliary and pancreatic tuberculosis: A two decade experience[J]. BMC Surg, 2007, 7(1):10.
- 6. Lee E, Holzman RS. Evolution and current use of the tuberculin test[J]. Clin Infect Dis, 2002, 34(3):365-370.
- 7. Ferrara G, Losi M, D’Amice R, et al. Use in routine clinical practice of two commercial blood tests for diagnosis of infection with Mycobacterium tuberculosis:a prospective study[J]. Lancet,.
- 8. Lee JY, Choi HJ, Park IN, et al. Comparison of two cornmercial interferon-gamma assays for diagnosing Mycobacteriumtuberculosis infection[J]. Eur Respir J, 2006, 28 (1):24-30.
- 9. Pai M, Zwerling A, Menzies D. Systematic review:T-cell based assays for the diagnosis of latent tuberculosis infection:an update[J]. Ann Intern Med, 2008, 149(3):177-184.
- 10. 張麗帆, 劉曉清. γ干擾素釋放分析T. SPOT. TB診斷結(jié)核感染臨床應用進展[J]. 中國醫(yī)學科學院學報, 2009, 3(4):506-510.
- 11. Mallery JS, Centeno BA, Hahn PF, et al. Pancreatic tissue sampling guided by EUS, CT/US, and surgery:a comparison of sensitivity and specificity[J]. Gastrointest Endosc, 2002, 56(2):218-224.
- 12. World Health Organization. Treatment of tuberculosis:guidelines for national programmes[EB/OL]. 3rd ed. Geneva, 2003, 27-38.http://whqlibdoc. who. int/hq/2003/who_cds_tb_2003. 313_Eng. pdf.
- 13. Iwai T, Kida M, Kida Y, et al. Biliary tuberculosis causing cicatricial stenosis after oral anti-tuberculosis therapy[J]. World J Gastroenterol, 2006, 12(30):4914-4917.
- 14. , 367(9519):1328-1334.