胸腺结核二例并文献复习

doi:10.3969/j.issn.1000-6621.2019.03.019

摘要/Abstract

摘要：

通过总结山东省胸科医院收治的1例胸腺结核+胸腺瘤和1例肺结核+胸腺结核+胸膜结核瘤患者的临床表现、辅助检查[包括胸部CT、腹部B超、结核菌素试验、结核感染T细胞斑点试验(T-SPOT.TB)等]、诊治过程及随访情况等临床资料,以及结合1958—2016年共21篇国内外相关文献,共计24例患者对胸腺结核的临床特点、诊断和治疗情况进行回顾性分析。认为胸腺结核极其罕见,胸部CT等影像学检查虽可提示病变,但不能确诊;细菌学、组织学和病原学检查可以明确诊断,故对纵隔肿物患者术前应进行病因学检查,尤其是结核病相关检查。对于疑诊为结核病的患者应术前给予诊断性抗结核药物治疗,并在符合手术指征后行手术切除病灶,术后继续坚持规范抗结核药物治疗可望治愈。

关键词: 结核, 胸腺, 胸腺切除术, 胸腺瘤, 共病现象, 总结性报告(主题)

Abstract:

In the study, we reported two cases who diagnosed as thymic tuberculosis (TB), their clinical characteristics, such as symptoms, image findings, tuberculin skin test, T-SPOT.TB, treatment and outcome, were summarized and evaluated, retrospectively. Moreover, between 1958 and 2016, patients with thymic TB (n=24) reported by others (21 studies) were also analyzed. Overall, thymic TB is extremely rare. Although routine chest CT and other image findings suggest the disease, it couldn’t confirm it. Nevertheless, bacteriological and histological examinations can make a definite diagnosis, so in order to identify the cause of mediastinal mass, these assays should be considered in practice. In addition, for management of suspected thymic TB patients, diagnostic treatment should be prescribed timely, and the lesions should be treated surgically when indications arise. Meanwhile, it is recommended to follow standard anti-TB treatment for a better outcome.

Key words: Tuberculosis, Thymus gland, Thymectomy, Thymoma, Comorbidity, Consensus development conferences as topic

刘大伟,朱建坤,金锋,王成,乔高锋,张运曾,赵彬. 胸腺结核二例并文献复习[J]. 中国防痨杂志, 2019, 41(3): 348-352. doi: 10.3969/j.issn.1000-6621.2019.03.019

Da-wei LIU,Jian-kun ZHU,Feng JIN,Cheng WANG,Gao-feng QIAO,Yun-zeng ZHANG,Bin ZHAO. Tuberculosis of the thymus—2 cases report and review of the literature[J]. Chinese Journal of Antituberculosis, 2019, 41(3): 348-352. doi: 10.3969/j.issn.1000-6621.2019.03.019

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文献序号	性别	年龄 (岁)	报道时间(年)	临床表现	并发疾病	检查项目	抗结核治疗方案
1	女	20	1992	咳嗽、呼吸困难4个月	肺结核	胸部CT检查(+);术后病理(+)	H-R-E-Z
3	女	28	1998	胸闷1年	胸腺瘤、纵隔淋巴结结核	胸部CT检查(+);术后病理(+)	未提及
4	男	68	2004	胸闷、憋气、胸痛6个月	胸腺瘤、纵隔淋巴结结核	胸部CT检查(+);术后病理(+)	9H-R-Sm
5	男	15	2011	胸痛、胸闷	无	结核菌素试验阴性,胸部CT检查(+);术后病理(+)	抗结核药物治疗6个月,随访12个月后无复发
6	男	46	2008	发热、咳嗽5个月	纵隔淋巴结结核	结核菌素试验弱阳性;胸部CT检查(+);术后病理(+)	抗结核药物治疗6个月,复查无复发
7	男男女	15 62 53	2014	进行性胸痛、呼吸困难	无	胸部CT检查(+);术后病理(+)	未提及
16	女	62	2005	轻度呼吸困难、前胸疼痛	乳腺癌	胸部CT检查(+);术后病理(+)	手术前后均未治疗
17	男	18	2007	进行性呼吸困难、胸痛	肺结核	胸部CT检查(+);术后病理(+)	未提及
18	男女	74 56	2007	因心脏病查体发现干咳	风湿性关节炎;糖尿病	胸部CT检查(+);术后病理(+)	具体未提及
21	男	0.5	2014	进行性呼吸困难	体质量偏低	结核菌素试验强阳性;胸部CT检查(+);术后病理(+)	2H-R-Z-Sm/T-H-R
22	女	12	2016	右颈部肿物伴咳嗽1个月	颈部淋巴结结核	胸部CT检查(+);术后病理(+):病灶抗酸杆菌(+)	抗结核药物治疗5个月后手术,术后给予二线抗结核药物治疗