本文關(guān)鍵詞：食管結(jié)核30例臨床診治分析　出處：《遵義醫(yī)學(xué)院》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 食管結(jié)核 內(nèi)鏡 臨床表現(xiàn) 治療

【摘要】：目的：探討食管結(jié)核的臨床表現(xiàn)、診斷及治療方法,旨在提高該病的診斷率,減少誤診率。 方法：回顧分析遵義醫(yī)學(xué)院附院2008年1月～2012年12月經(jīng)內(nèi)鏡檢查發(fā)現(xiàn)的30例食管結(jié)核的臨床表現(xiàn)、內(nèi)鏡特點、實驗室及影像學(xué)檢查、治療等臨床資料。 結(jié)果：30例患者中,表現(xiàn)吞咽困難11例(36.7%),進食阻擋感7例(23%),胸骨后疼痛10例(33.3%),上腹隱痛不適1例(3.3%)；上腹燒灼樣疼痛1例(3.3%)；其中伴有結(jié)核中毒癥狀的14例(46.7%),主要表現(xiàn)為乏力、低熱、納差、盜汗。內(nèi)鏡表現(xiàn)：病變位于食管上段2例(3.3%),中段25例(83.3%),下段3例(10%),隆起病變14例(46.7%),其中伴潰瘍的11例(36.7%),伴表面光滑的3例(10%),潰瘍12例(40%),潰瘍苔較薄且潔凈,食管狹窄4例(13.3%)；內(nèi)鏡下活檢陽性8例(26.7%),潰瘍性病變與隆起性病變內(nèi)鏡活檢陽性率無顯著差異(P0.05)；超聲內(nèi)鏡表現(xiàn)為食管壁全層增厚,以固有肌層明顯,層次結(jié)構(gòu)不清,部分食管外膜中斷,壁內(nèi)見低回聲病變,其內(nèi)見點狀高回聲影,增厚食管旁可見數(shù)個腫大鈣化淋巴結(jié),其中超聲內(nèi)鏡誤診一例。本組患者有11例接受胸部x線片檢查,發(fā)現(xiàn)肺結(jié)核5例(16.7%),19例接受胸部CT平掃檢查發(fā)現(xiàn)肺結(jié)核10例(33.3%),其中雙肺粟粒型肺結(jié)核2例(6.7%),伴有空洞型肺結(jié)核的2例(6.7%),肺部纖維化和(或)鈣化灶11例(36.7%),肺部未見異常的4例(13.3%)。其中有4例(20%)胸部CT平掃提示縱膈腫大的鈣化淋巴結(jié)。血沉增快5例(16.7%),PPD陽性16例(64%),其中強陽性4例(16%)。所有患者均經(jīng)抗結(jié)核治療后癥狀緩解；治療6月后復(fù)查內(nèi)鏡結(jié)果：隆起病變中有1例病變完全消失,其余13例病灶明顯縮小或出現(xiàn)潰瘍瘢痕,食管狹窄已恢復(fù),潰瘍型病變見假憩室形成及潰瘍瘢痕,無一例需手術(shù)治療。 結(jié)論：食管結(jié)核主要表現(xiàn)為吞咽困難或進食阻擋感、胸骨后疼痛。胃鏡下主要表現(xiàn)為潰瘍、粘膜隆起、狹窄,食管結(jié)核好發(fā)于食管中段,內(nèi)鏡活檢陽性率低,潰瘍性病變與隆起性病變內(nèi)鏡活檢陽性率無顯著差異(P0.05)；超聲內(nèi)鏡對食管結(jié)核的診斷及鑒別診斷具有重要價值,大多數(shù)食管結(jié)核合并肺結(jié)核。聯(lián)合運用胃鏡、超聲內(nèi)鏡、影像學(xué)及實驗室檢查能提高該病的診斷率,減少誤診率。食管結(jié)核經(jīng)抗結(jié)核治療效果好,一般無需手術(shù)治療。
[Abstract]:Objective: to investigate the clinical manifestations, diagnosis and treatment of esophageal tuberculosis in order to improve the diagnosis rate and reduce the misdiagnosis rate. Methods: the clinical manifestations, endoscopic features, laboratory and imaging findings of 30 cases of esophageal tuberculosis from January 2008 to 2012 in affiliated Hospital of Zunyi Medical College were retrospectively analyzed. Clinical data such as treatment. Results among the 30 patients, 11 had dysphagia (36.7%), 7 had food obstruction (2323), and 10 had back sternal pain (33.3%). There was 1 case with pain in the upper abdomen and 3. 3% of the stomach. Burning pain in the upper abdomen was found in 1 case. Among them, 14 cases with tuberculosis poisoning symptoms were 46.7%, mainly manifested as fatigue, low fever, anorexia, night sweat.Endoscopic manifestation: the lesion was located in the upper esophagus in 2 cases. There were 25 cases in the middle segment, 3 cases in the lower segment, 10 cases in the lower segment, and 14 cases in the uplift lesions. Among them, there were 11 cases with ulcer and 36.7%, and 3 cases with smooth surface. The ulcer was thin and clean in 12 cases, and the esophageal stricture was 13. 3% in 4 cases. The positive rate of endoscopic biopsy in 8 cases was 26.7%. There was no significant difference in the positive rate of endoscopic biopsy between ulcerative lesions and protuberant lesions (P 0.05). Endoscopic ultrasonography showed that the whole layer of the esophagus wall was thickened obviously in the lamina propria muscularis with unclear hierarchical structure interrupted part of the esophageal adventitia hypoechoic lesions in the wall and dot hyperechoic lesions in the wall. There were several enlarged and calcified lymph nodes around the thickened esophagus, of which one case was misdiagnosed by endoscopic ultrasonography. In this group, 11 cases received chest X-ray examination and 5 cases were found to have pulmonary tuberculosis (16. 7%). Ten cases of pulmonary tuberculosis were diagnosed by plain chest CT scan, among which 2 cases of double pulmonary miliary pulmonary tuberculosis were involved with 6.7T, and 2 cases with cavitary pulmonary tuberculosis (2 cases with cavity pulmonary tuberculosis). Pulmonary fibrosis and / or calcification were found in 11 cases (36.7%). 4 cases with no abnormal lung were found 13. 3% of them. Among them, 4 cases (20%) showed mediastinal enlargement of calcified lymph nodes by plain CT scan, and 5 cases of ESR increased 16.7% (P < 0 05). PPD was positive in 16 cases, of which 4 cases were strongly positive. All the patients were relieved after anti-tuberculosis treatment. The results of endoscopic examination after June showed that 1 case of protuberance lesion completely disappeared, the remaining 13 cases of lesion obviously reduced or appeared ulcer scar, esophageal stenosis has recovered. Pseudo diverticulum formation and ulcer scar were found in ulcerative lesions. Conclusion: the main manifestations of esophageal tuberculosis are dysphagia or dysphagia, poststernal pain, gastroscopy is mainly ulcer, mucosal bulge, stricture, esophageal tuberculosis in the middle esophagus, the positive rate of endoscopic biopsy is low. There was no significant difference in the positive rate of endoscopic biopsy between ulcerative lesions and protuberant lesions (P 0.05). EUS plays an important role in the diagnosis and differential diagnosis of esophageal tuberculosis. The combined use of gastroscope, endoscopic ultrasonography, imaging and laboratory examination can improve the diagnosis rate of this disease. Reduce the rate of misdiagnosis. Esophageal tuberculosis by anti-tuberculosis treatment is good, generally no surgical treatment.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R523

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