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1、XX大学毕业论文食管结核的诊断与外科治疗姓名:2014年6月25日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显示纵隔或隆凸卜•淋巴结肿大伴有强化环(62.50%),76.92%(20/26例)被误诊为
2、食管肿瘤。实施食管切除7例(26.92%),病灶清除17例(65.38%),胃造痿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。伴冇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]ObjectiveToexplorethediagnosisandsurgicaltreatmentoftheesophagealtuberculosis.MethodsThepathologicclassification、clinical
3、characteristicsandtreatmentmethodsof26patientswiththeesophagealtuberculosiswereretrospectivelyanalyzedinourhospitalfromJanuary1980toAugust2003.ResultsPrimarytuberculosisofesophagusin6patients(23.08%),secondaryin20patients(76.92%).Thesickrateoffemalewiththeesophagealtuberc
4、ulosiswashigherthanmale(1.2:1),50yearsoldbelowoccupied70.08%,dysphagiaoccupied100.00%,nopatientshadtoxicsymptomsoftuberculousinfection,thepositiverate(22.22%)ofbiopsywaslowerbyendoscopy,76.92%oftheillnessweremisdiagnosedasesophagealturnor.TheCTshowedtheesophagealwalltoinc
5、reasethethickcompanionperiesophagealortheconvexbelowthelymphoidnodestoenlargeand62.50%ofcaseshadtoenhancethewreathonplainscans.Theesophagectomyin7patients(26.92%),lymphoidectomyorfocusesdebridementinl7patients(65.38%),gastrecstomyin2patients(7.69%).Thisgrouphadnotheoperat
6、ivedeathandseriouscomplications.ConclusionThepositiverateofbiopsybyendosccpyislower,misdiagnosticrateishigherofesophagealtuberculosis.TheCTiscontaincertainhelpfordiagnosisofsecondaryesophagealtuberculosis,andwithesophagealperforationorthemechanicalobstructionshouldbeopera
7、ted・Keywordsesophagealtuberculosispathologicclassificationclinicalcharacteristicssurgicaltreatment近年來,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多年來经内镜、手术病理证实的食管结核26例进行总结分析,旨在提高对食管结核的诊治水平。1资料与方法1.1-般资料1980年1月〜2003年8月我院收治食管结核26例,男12例,女14例,年龄32〜74岁。其基木情况见表1。木组病程2
8、周〜2个月,吞咽梗阻主要以咽下不畅(100.00%)和胸骨后吞咽痛为主。既往有结核史6例,入院时冇肺结核3例(其屮伴颈部淋巴结结核性脓肿2例)冇全身感染症状外,仅2例有低热、盗汗、乏力,其余均