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目的总结脾结核的临床诊断和治疗体会。方法回顾性分析广西医科大学第一附属医院肝胆外科1995～2005年收治12例脾结核病人的临床资料。主要临床表现为长期发热、纳差、消瘦、左上腹痛,脾肿大伴贫血。B超、CT检查均提示脾肿大,其中11例示脾内占位病变。6例手术治疗,术后均予正规的抗结核治疗,另6例保守治疗。结果全部病人均恢复良好,能正常生活、工作。结论脾肿大伴发热、纳差、消瘦、左上腹痛、贫血等时,应考虑该病可能,尤其是合并脾外结核者。影像学检查对诊断有价值但无特异性。对孤立性或某些多发性脾结核,不能排除脾脏恶性肿瘤时,手术既能明确诊断,又能达到治疗目的。无论手术与否,均应给予正规抗结核治疗。
Objective To summarize the clinical diagnosis and treatment of splenic tuberculosis. Methods The clinical data of 12 patients with splenic tuberculosis who undergone hepatobiliary surgery in the First Affiliated Hospital of Guangxi Medical University from 1995 to 2005 were retrospectively analyzed. The main clinical manifestations of long-term fever, anorexia, weight loss, left upper quadrant pain, splenomegaly with anemia. B ultrasound, CT examination showed splenomegaly, including 11 cases of spleen lesions. 6 cases of surgical treatment, postoperative to regular anti-TB treatment, the other 6 cases of conservative treatment. Results All patients recovered well, able to live and work normally. Conclusion Splenomegaly with fever, anorexia, weight loss, left upper quadrant pain, anemia, etc., should consider the disease may be, especially those with splenic tuberculosis. Imaging examination is valuable but not specific for diagnosis. For isolated or some multiple splenic tuberculosis, can not rule out spleen cancer, the operation can not only confirm the diagnosis, but also to achieve the purpose of treatment. Whether surgery or not, should be given regular anti-TB treatment.