食管结核的诊断与外科治疗.docVIP

食管结核的诊断与外科治疗 【关键词】 食管结核 【摘要】 目的 探讨食管结核的诊断与外科治疗。方法 回顾性分析了我院1980年1月～2003年8月收治食管结核26例的分型、临床特征与诊治方法。结果 原发性7例（26.92%），继发性19例（73.08%）。女性患病率高于男性（1.2:1），50岁以下占70.08%，吞咽困难为100.00%，无典型结核中毒症状，内镜活检阳性率低（22.22%），CT显示纵隔或隆凸下淋巴结肿大伴有强化环（62.50%），76.92%（20/26例）被误诊为食管肿瘤。实施食管切除7例（26.92%），病灶清除17例（65.38%），胃造瘘2例（7.69%）。全组无手术死亡及严重并发症。结论 食管结核的内镜阳性率低，误诊率高。CT对继发性食管结核的诊断有一定的帮助。伴有并发症或机械性梗阻者应手术治疗。 关键词 食管结核 病理分型 临床特征 外科治. 【Abstract】 Objective To explore the diagnosis and surgical treatment of the esophageal tuberculosis. Methods The pathologic classification，clinical characteristics and treatment methods of26patients with the esophageal tuberculosis were retrospectively analyzed in our hospital from January1980to August2003.Results Primary tuberculosis of esophagus in6patients（23.08%），secondary in20patients（76.92%）.The sick rate of female with the esophageal tuberculosis was higher than male（1.2:1），50years old below occupied70.08%，dysphagia occupied100.00%，no patients had toxic symptoms of tuberculous infection，the positive rate（22.22%）of biopsy was lower by endoscopy，76.92%of the illness were misdiagnosed as esophageal tumor.The CT showed the esophageal wall to increase the thick companion periesophageal or the convex below the lymphoid nodes to enlarge and 62.50%of cases had to enhance the wreath on plain scans. The esophagectomy in7patients（26.92%），lymphoidectomy or focuses debridement in17patients（65.38%），gastrecstomy in2patients（7.69%）.This group had no the operative death and serious complications.Conclusion The positive rate of biopsy by endosccpy is lower， misdiagnostic rate is higher of esophageal tuberculosis.The CT is contain certain help for diagnosis of secondary esophageal tuberculosis，and with esophageal perforation or the mechanical obstruction should be operated. Key words esophageal tuberculosis pathologic classification clinical characteristics surgical treatment 近年来，肺结核病的发病率有上升的趋势，食管结核的发病亦不例外，其临床症状和食管造影极易误诊为食管肿瘤。本文对我院20多年来经内镜、手术病理证实