食管结核30例临床诊治分析

发布时间：2018-01-14 08:00

本文关键词：食管结核30例临床诊治分析　出处：《遵义医学院》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨食管结核的临床表现、诊断及治疗方法,旨在提高该病的诊断率,减少误诊率。方法：回顾分析遵义医学院附院2008年1月～2012年12月经内镜检查发现的30例食管结核的临床表现、内镜特点、实验室及影像学检查、治疗等临床资料。结果：30例患者中,表现吞咽困难11例(36.7%),进食阻挡感7例(23%),胸骨后疼痛10例(33.3%),上腹隐痛不适1例(3.3%)；上腹烧灼样疼痛1例(3.3%)；其中伴有结核中毒症状的14例(46.7%),主要表现为乏力、低热、纳差、盗汗。内镜表现：病变位于食管上段2例(3.3%),中段25例(83.3%),下段3例(10%),隆起病变14例(46.7%),其中伴溃疡的11例(36.7%),伴表面光滑的3例(10%),溃疡12例(40%),溃疡苔较薄且洁净,食管狭窄4例(13.3%)；内镜下活检阳性8例(26.7%),溃疡性病变与隆起性病变内镜活检阳性率无显著差异(P0.05)；超声内镜表现为食管壁全层增厚,以固有肌层明显,层次结构不清,部分食管外膜中断,壁内见低回声病变,其内见点状高回声影,增厚食管旁可见数个肿大钙化淋巴结,其中超声内镜误诊一例。本组患者有11例接受胸部x线片检查,发现肺结核5例(16.7%),19例接受胸部CT平扫检查发现肺结核10例(33.3%),其中双肺粟粒型肺结核2例(6.7%),伴有空洞型肺结核的2例(6.7%),肺部纤维化和(或)钙化灶11例(36.7%),肺部未见异常的4例(13.3%)。其中有4例(20%)胸部CT平扫提示纵膈肿大的钙化淋巴结。血沉增快5例(16.7%),PPD阳性16例(64%),其中强阳性4例(16%)。所有患者均经抗结核治疗后症状缓解；治疗6月后复查内镜结果：隆起病变中有1例病变完全消失,其余13例病灶明显缩小或出现溃疡瘢痕,食管狭窄已恢复,溃疡型病变见假憩室形成及溃疡瘢痕,无一例需手术治疗。结论：食管结核主要表现为吞咽困难或进食阻挡感、胸骨后疼痛。胃镜下主要表现为溃疡、粘膜隆起、狭窄,食管结核好发于食管中段,内镜活检阳性率低,溃疡性病变与隆起性病变内镜活检阳性率无显著差异(P0.05)；超声内镜对食管结核的诊断及鉴别诊断具有重要价值,大多数食管结核合并肺结核。联合运用胃镜、超声内镜、影像学及实验室检查能提高该病的诊断率,减少误诊率。食管结核经抗结核治疗效果好,一般无需手术治疗。
[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.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R523

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