目的探讨肝结核病的临床诊断及误诊原因。方法对我院普外科1996~2001年收治的8例肝结核病患者的临床资料进行回顾性分析。结果本组病例中发热5例，A/G倒置6例，甲胎蛋白均阴性； OT或PPD皮试5例，4例阴性，1例可疑； CT发现腹主动脉旁淋巴结肿大3例。入院诊断肝结核1例，原发性肝癌或转移性肝癌3例，肝血管瘤1例，肝脓肿2例，肝包虫病1例。剖腹探查、肝部分切除、活检6例，肝脓肿引流2例，术中冰冻切片检查证实均为结核。结论对于肝功能大致正常、甲胎蛋白阴性的中、青年患者，如CT或B超发现肝区有多发性占位病变并伴午后发热、A/G倒置、有肝外结核病史或表现者，应高度怀疑本病。经皮肝穿刺或腹腔镜下行肝活检是确诊本病的首选方式； 如无法与肝恶性肿瘤鉴别，应尽早行剖腹探查术，术中常规作冰冻检查，术后行正规抗痨治疗，可治愈该病。
Objective To investigate the clinical and imaging manifestations, laboratory examination, diagnosis, treatment and prognosis of hepatic tuberculosis, and improve the understanding of hepatic tuberculosis. Methods One case of hepatic tuberculosis that treated by author was reported, at the same time, the domestic literatures were retrieved from 2000 to 2015, 158 cases of hepatic tuberculosis were collected, and the clinical manifestations, imaging examination, diagnosis and prognosis of 159 cases were analyzed. Results ①In 159 cases, male patients were in the majority, male and female ratio was about 2:1. Symptom with fever (68.55%), liver discomfort (43.40%), loss of appetite and fatigue (40.88%) were the main performance. ②Results of laboratory examination: erythrocyte sedimentation rate increased (71.76%), abnormal liver function (58.49%), and lower hemoglobin (52.83%). ③The comparation of imaging diagnosis: the positive rates of CT and B-ultrasound were no significant difference (P＞0.05), there existed significantly difference between MRI, B-ultrasound and CT, MRI had a higher positive rate (P＜0.05). ④The preoperative diagnosis rate of hepatic tuberculosis about 13.84%, was low. The misdiagnosis rate was high, during which liver cancer were the most common misdiagnosed. Diagnosis mainly depends on pathological examination. ⑤Medical treatment was the main treatment, and it’s effect was good. Conclusions Hepatic tuberculosis lacked specific clinical manifestations, and the imaging features of various, the diagnostic rate of hepatic tuberculosis was low, and the misdiagnosis rate was high. In order to definite it, histopathological examination is necessary. The first choice of treatment is drug therapy, which is good.