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目的探讨腱鞘结核的误诊原因及减少误诊发生的对策。方法回顾性分析1991年1月至2003年12月收治的15例腱鞘结核患者诊治过程,总结分析其临床特点及误诊原因。结果本组病例发病到确诊时间为2～36个月,平均为(16±10)个月;其中12例术前误诊。病例均采用手术切除并全身化疗的治疗方式,除1例术后2个月失访外,其余病例随访2.5～7.0年,平均4.6年,未见复发或身体其他地方出现结核灶。失访1例为红斑狼疮应用免疫抑制剂治疗的患者,术后1个月发现病变对侧腕、踝关节结核。结论缺乏典型临床表现、过分依赖实验室检查是延误早期确诊的重要原因;应对可疑病例进行常规结核排查,穿刺抽液进行病原学检查,术中病理检查有利于确诊。
Objective To investigate the causes of misdiagnosis of tendon sheath tuberculosis and the countermeasures to reduce the misdiagnosis. Methods The diagnosis and treatment of 15 cases of tendon sheath tuberculosis admitted from January 1991 to December 2003 were retrospectively analyzed. The clinical features and causes of misdiagnosis were analyzed. Results The diagnosis of this group of patients to the time of 2 to 36 months, with an average of (16 ± 10) months; of which 12 cases were misdiagnosed preoperatively. Cases were treated with surgical resection and systemic chemotherapy, except 1 case 2 months after the loss of follow-up, the remaining cases were followed up 2.5-7.0 years, an average of 4.6 years, no recurrence or tuberculosis occurred elsewhere in the body. One patient lost to lupus erythematosus was treated with immunosuppressive agents. One month after operation, the lesion was found on the lateral wrist and ankle joint. Conclusion The lack of typical clinical manifestations, over-reliance on laboratory tests is an important reason for the delay of early diagnosis; suspicious cases should be routine tuberculosis screening, puncture fluid for etiological examination, intraoperative pathological examination is conducive to the diagnosis.