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脾脏结核、腹腔淋巴结结核临床上少见,且由于其临床表现不典型而容易误诊。现将我院脾脏、腹腔淋巴结结核误诊为恶性淋巴瘤2例报告如下。 例1:男性,29岁。因反复发热、乏力3个月,经B超检查,诊断恶性淋巴瘤于1992年4月入院。体检:贫血貌、浅表淋巴结未触及,脾肋下3cm,无压痛。心肺听诊正常。血 WBC5.4×10~9/L,血 Hb105g/L,血ESR125mm/h,胸片正常,B超示腹腔淋巴结肿大,脾内淋巴瘤浸润。给氮芥、阿糖胞苷、阿霉素及强的松联合化疗,体温恢复正常,B超复查:脾脏、腹腔淋巴结明显缩小。但胸片复查示左上肺结核,故怀疑脾脏结核可能,行剖腹探查:脾脏20cm×14cm×6cm,质中,整个脾脏密布黄豆大小结节,胰头胰体周围均有多个肿大淋巴结,行睥切除及腹腔淋巴结活检,病理报告均为“结核”。术后给予链霉素、利福平、雷米封抗结核治疗,2个月后胸片复查左上肺结核病灶明显吸收,腹部B超腹腔内未探及肿大淋巴结。
Spleen tuberculosis, peritoneal lymph node tuberculosis is clinically rare, and because of its clinical manifestations of atypical misdiagnosis. Now our hospital spleen, abdominal lymph node tuberculosis misdiagnosed as malignant lymphoma in 2 cases reported as follows. Example 1: Male, 29 years old. Due to repeated fever, fatigue 3 months, the B-ultrasound, diagnosis of malignant lymphoma was admitted to hospital in April 1992. Physical examination: anemia appearance, superficial lymph nodes not touched, spleen ribs 3cm, no tenderness. Cardiopulmonary auscultation normal. Blood WBC5.4 × 10 ~ 9 / L, blood Hb105g / L, blood ESR125mm / h, chest X-ray, B ultrasound showed abdominal lymph nodes, splenic lymphoma infiltration. To nitrogen mustard, cytarabine, doxorubicin and prednisone combined with chemotherapy, body temperature returned to normal, B-ultrasound: spleen, abdominal lymph node was significantly reduced. However, chest X-ray examination of the upper left pulmonary tuberculosis, it is suspected splenic tuberculosis possible, laparotomy exploration: spleen 20cm × 14cm × 6cm, the quality of the entire spleen dense soy size nodules, pancreatic head and pancreas around the number of multiple enlarged lymph nodes睥 resection and abdominal lymph node biopsy, pathological reports are “tuberculosis.” Postoperative streptomycin, rifampicin, Remy sealed anti-tuberculosis treatment, 2 months after chest X-ray examination of tuberculosis lesions were significantly absorbed, abdomen abdominal ultrasound and enlarged lymph nodes.