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目的探讨肝结核病误诊原因及临床诊断。方法回顾性分析西藏自治区人民医院外一科2007-2010年误诊为肝泡球蚴病的肝结核病3例临床资料。结果经治疗6～12个月,随访后2例痊愈,1例仍在随访。结论肝泡球蚴病流行地区如有长期不明原因低热、肝肿大、CT提示肝内不规则低密度影,肝内“粉末状”钙化灶或肝内低密度影中可见斑点状高密度影,腹腔内未见肿大的淋巴结影,γ-球蛋白轻度升高,A/G倒置,AFP阴性的患者,尤其是有体内其他脏器的结核灶,应考虑肝结核可能,并可行肝穿刺或腹腔镜下检查、活检,以明确诊断,避免漏诊。确诊后行正规抗结核治疗。
Objective To investigate the causes and clinical diagnosis of misdiagnosis of liver tuberculosis. Methods The clinical data of 3 cases of hepatic tuberculosis misdiagnosed as alveolar hydatidosis from 2007 to 2010 in People’s Hospital of Tibet Autonomous Region were retrospectively analyzed. Results After 6 to 12 months of treatment, 2 cases recovered after follow-up, and 1 case was still followed up. Conclusions In the endemic areas of Hepatocytopenia, if there are long-term unexplained fever, hepatomegaly, CT may indicate abnormal low-density intrahepatic lysis, speckled hyperplasia in intrahepatic “powdery” calcification or intrahepatic low density Density of the shadow, no enlarged abdominal lymph nodes, γ-globulin mildly elevated, A / G inversion, AFP negative patients, especially with other organs of the body’s tuberculosis should consider the possibility of liver tuberculosis and Possible liver puncture or laparoscopic examination, biopsy to confirm the diagnosis, to avoid missed diagnosis. After the diagnosis of regular anti-TB treatment.