Objectives: To study the clinical characteristics of pancreatic tuberculosis, and therefore to improve the diagnosis and treatment of this disease. Methods: The clinical data of 10 patients with pancreatic tuberculosis form 1990 to 2017 were reviewed, including clinical characteristics, laboratory tests and imaging features. Results: The ten patients aged 28 to 71 (median 56) years. All of them presented varying degrees of abdominal pain and weight loss (3 to 8 kg). Hypo-echoic pancreatic masses were shown by abdominal ultra-sound in 7 cases, and cystic-solid masses with thick wall was shown by abdominal CT scan in 4 cases, but dilatation of the pancreatic duct was found in none of the 10 cases. Hemoglobin levels lower than 12 g/L were found in 6 cases, and ESR more than 20 mm/1 h was present in 7 cases. Four cases received PPD test, but only one was positive. CA19-9 was found to be higher than normal (27 IU/ml) in 3 cases (39.2 IU/ml, 125.7 IU/ml, 88.9 IU/ml respectively). Three cases received T-spot.TB tests, and all the results were positive. Seven cases received laparotomy, and the other 3 received endoscopic ultrasound-guided biopsy. Caseous necrosis and Langerhans cells were found in all the 10 cases. Nine patients were treated by 6 to 12 months' anti-tuberculosis therapies, and at 1-5 years' follow-up, 8 were cured and 1 improved. Conclusions: The manifestations of pancreatic tuberculosis were easy to be confused with other diseases, and therefore a comprehensive understanding of history and careful examinations were important for a correct diagnosis. Once the diagnosis was made, prompt standard anti-tuberculosis therapy could lead to a favorable outcome.
目的： 分析胰腺结核的临床表现，提高对该病的认识及诊疗水平。 方法： 回顾1990—2017年收治的10例胰腺结核病例，分析其病史、诊疗过程及预后。 结果： 10例患者中，男7例，女3例，年龄28~71岁，中位年龄56岁；均存在不同程度的腹痛及消瘦（3~8 kg）；7例腹部超声表现为胰腺低回声占位性病变；4例腹部CT以分隔较厚的囊实性占位性病变为主要表现；10例均未见胰管增宽；血红蛋白<12 g/L者6例；ESR>20 mm/1 h者7例；4例行结核菌素纯蛋白衍化物试验，仅1例强阳性；CA19-9异常升高3例，分别为39、126及89 IU/ml（参考值<27 IU/ml）；3例行结核特异性T细胞酶联免疫斑点检测（T-SPOT.TB）检测，均为阳性。7例接受手术探查切取部分病灶组织，3例行超声引导下胰腺病灶穿刺活检；10例病理组织学均发现干酪样坏死及朗格汉斯细胞而确诊。除1例失访外，其余患者均接受6~12个月的抗结核治疗，随访时间1~5年，8例已获得痊愈，1例尚在随访中（症状明显缓解）。 结论： 胰腺结核临床表现缺乏特异性，易与其他胰腺疾病混淆。对可疑病例行超声内镜引导下穿刺活检利于确诊。经及时、规范的抗结核治疗可痊愈，预后良好。.
Keywords: Pancreas; Tuberculosis.