Endoscopic ultrasound-guided fine needle aspiration for the diagnosis of pancreatic tuberculosis in 14 cases
曹卉 1王晓林 1邓伊 1杜凡2
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作者信息
1. 华中科技大学同济医学院附属梨园医院消化内科,武汉 430066
2. 华中科技大学同济医学院附属协和医院消化内科,武汉 430022
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摘要
总结胰腺结核的临床特点,分析其超声内镜下表现、穿刺组织病理学及病原学结果.回顾性分析2018年1月至2022年1月在武汉协和医院收治的14例胰腺结核患者的病史、临床表现、实验室检查、影像学检查、超声内镜检查(endoscopic ultrasonography,EUS)下的表现、超声内镜引导细针穿刺抽吸术(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)获得的组织病理及病原学结果.胰腺结核患者中,男、女各7例,年龄(39.7±16.0)岁,临床表现主要为腹胀、腹痛、食欲下降、体重减轻、腹部包块、梗阻性黄疸、皮肤瘙痒、无症状等.7例患者合并其他器官结核,其中3例合并肺结核.实验室检查示贫血7例,血淀粉酶升高3例,胆红素升高2例,结核抗体阳性10例,结核T-SPOT阳性12例,患者CA19-9水平均正常.影像学检查示实性肿块9例,囊实性肿块4例,囊性占位1例,胰周淋巴结增大4例,胆管扩张2例.EUS示胰腺结核好发于胰头部.病灶EUS下均呈低回声,无血管侵犯,其中均匀低回声8例,不均匀低回声6例;病灶内部见高回声钙化灶2例,见无回声液化坏死区1例;病灶肿块长径(3.9±1.6)cm,其中肿块长径＜3 cm者5例,肿块长径≥3 cm者9例.组织学检查示干酪样肉芽肿12例.病原学检查结果显示结核杆菌聚合酶链式反应检测阳性11例,抗酸染色找到阳性分枝杆菌3例,培养出结核分枝杆菌1例.全部患者确诊后给予正规药物抗结核治疗,3例黄疸患者行内镜逆行胰胆管造影术及胆道支架置入术.随访期间患者显示预后良好.对于胰腺占位性病变患者,应考虑胰腺结核的可能,胰腺结核的诊断依靠组织活检及病原学检查,EUS-FNA是获取胰腺组织首选的方法,可避免不必要的手术,并提供及时、准确的诊断.正规抗结核治疗是胰腺结核的主要治疗方法.
Abstract
To summarize the clinical features of pancreatic tuberculosis,analyze its endoscopic ultrasonography(EUS)findings,aspiration histopathology and etiological results,the medical history,clinical manifestations,laboratory tests,imaging findings,EUS findings,pathological and etiological results of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)biopsy,of 14 patients with pancreatic tuberculosis in Wuhan Union Hospital from January 2018 to January 2022 were retrospectively analyzed.Among the patients with pancreatic tuberculosis,7 were male and 7 were female with the age of 39.7±16.0 years.The main clinical manifestations were abdominal distention,abdominal pain,loss of appetite,weight loss,abdominal mass,obstructive jaundice,skin pruritus,asymptomatic.Seven patients with pancreatic tuberculosis were complicated with tuberculosis in other organs,including 3 patients with pulmonary tuberculosis.Laboratory examination results showed 7 patients with anemia,3 with elevated serum amylase,2 with elevated bilirubin and 10 with positive anti-tuberculosis antibody,12 positive for tuberculosis T-SPOT.Levels of CA19-9 in all patients were within normal range.Imaging examination results showed that 9 cases were solid mass,4 cystic solid mass,1 cystic mass,4 with enlarged peripancreatic lymph node,and 2 with dilated bile duct.EUS showed that head of pancreas was the most common location of pancreatic tuberculosis.All the lesions were hyperechoic without vascular invasion,including 8 cases with homogeneous hyperecho,6 cases with inhomogeneous hyperecho,2 cases with hyperechoic calcification and 1 case of echoless colliquative necrosis area.The diameter of the mass was 3.9±1.6 cm,with 5 cases＜3 cm and 9 cases ≥3 cm.Pathological biopsy showed 12 cases of caseous granuloma.Etiological examination results showed that 11 cases were positive for polymerase chain reaction for mycobacterium tuberculosis,3 positive for acid-fast stain,1 positive for culture.All the patients were treated with regular anti-tuberculosis drugs,and 3 patients with jaundice were treated with endoscopic retrograde cholangiopancreatography and biliary stent placement.All patients showed good prognosis during the follow-up period.For patients with pancreatic space-occupying lesions,the possibility of pancreatic tuberculosis should be considered.The current diagnostic method relies on tissue biopsy and aetiological examination.EUS-FNA is the preferred method for obtaining pancreatic tissue to avoid unnecessary surgery,and to provide timely and accurate diagnosis.Regular anti-tuberculosis treatment is the main treatment for pancreatic tuberculosis.
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