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患者,男,54岁,农民,上腹部胀痛、乏力纳差、消瘦,有黄疸、腹部包块,来我院就诊。 B超(IDE)检查:受检者禁食8小时以上,饮水500ml左右,平卧位、半卧位、左(或右)侧卧位,对胰腺进行多切面检查,胰头部可见5.3cm×3.6cm的囊性混合性肿块,胆总管胰头段受压。 术前超声误诊原因:①由于本病声像图缺乏特异性,与胰腺肿瘤有相似之处,而胰腺结核临床少见,认识不足,给超声造成一定困难。②患者全身症状及腹部体征不典型。医生只注意局部肿块,而忽视全身检查。③诊断思维狭窄,操作者经验不足,孤立地对待超声的局部发现,对临床资料缺乏系统分析。④对胰腺结核的诊断,必须结合病史、体征及其中实验检查,全面综合分析,抗结核治疗观察肿块大小变化或超声引导下穿刺活检,以提高诊断准确率,减少误诊。
Patient, male, 54 years old, farmer, abdominal pain, poor appetite, weight loss, jaundice, abdominal mass, come to our hospital. B (IDE) examination: Subjects fasted for more than 8 hours, drinking water about 500ml, supine, semi-recumbent position, left (or right) lateral position, multi-slice examination of the pancreas, pancreatic head visible 5.3cm × 3.6cm cystic mixed mass, common bile duct pancreatic head compression. Causes of preoperative ultrasound misdiagnosis: ① due to the lack of specificity of this disease sonogram, and pancreatic tumors have similarities, and pancreatic tuberculosis clinical rare, lack of understanding, to ultrasound caused some difficulties. ② patients with systemic symptoms and signs of atypia. Doctors only pay attention to local lumps, while ignoring the body examination. ③ diagnostic thinking is narrow, the operator lack of experience, isolated ultrasound treatment of local findings, the lack of systematic analysis of clinical data. ④ The diagnosis of pancreatic tuberculosis must be combined with history, signs and laboratory tests, a comprehensive and comprehensive analysis of anti-TB treatment of tumor size changes or ultrasound-guided biopsy to improve the diagnostic accuracy and reduce misdiagnosis.