背景:副球菌真菌病(PCM)可能累及肝蒂和胰周淋巴结,对胆管造成损害并显现出来,异常,结合肝外胆汁淤积(EHC),使调查和治疗具有挑战性。
目的:探讨EHC收治的内脏PCM患者的治疗方法。
方法:所有诊断为PCM的患者在公共场所接受治疗,对1982年至2020年的三级教学医院进行了回顾性评估。经EHC确认的患者根据治疗方法分为两组,目的是比较临床,实验室,和影像学发现,用于病因诊断的资源,治疗结果,和预后。使用线性混合效应模型(随机效应和固定效应)进行统计分析,使用SAS®9.0软件的PROC混合程序进行调整,和费希尔的精确检验。
结果:在1645例诊断为PCM的患者中,40人(2.4%)进行了EHC。其中,20人(50.0%)居住在农村地区,29人(72.5%)是男性,平均年龄27.1岁(3-65岁)。以黄疸为首发症状,体重下降至少10kg的患者有16例(40.0%),8例(20.0%)胰头有肿块。通过术中组织采集4例(10.0%),通过内窥镜检查3例(7.5%)进行病因诊断。27名患者(67.5%)单独接受药物治疗(第1组),而13例(32.5%)接受内镜和/或外科手术联合药物治疗(第2组).两组的EHC均显著减少(第1组40.7%,平均时间为3个月;第2组38.4%,平均时间为7.5个月),它们之间没有统计学上的显著差异。EHC复发率,主要与治疗不依从性有关,两组相似:第一组为37%,第二组为15.4%。第1组的死亡率为18.5%,第2组的死亡率为23%,生存率估计为71.3%和72.5%,分别,差异无统计学意义。
结论:尽管与PCM相关的EHC很少见,它需要包括在恶性肿瘤的鉴别诊断中,作为及时治疗可以预防肝外后遗症。
BACKGROUND: Paracoccidioidomycosis (PCM) may involve the hepatic pedicle and peripancreatic lymph nodes, cause damage to the bile duct and manifest, exceptionally, in combination with extrahepatic
cholestasis (EHC), making investigation and treatment challenging.
OBJECTIVE: To investigate the management of patients with visceral PCM admitted with EHC.
METHODS: All patients diagnosed with PCM treated in a public, tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated. Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical, laboratory, and imaging findings, resources used for etiological diagnosis, treatment results, and prognosis. Statistical analyses were performed using the linear mixed-effects model (random and fixed effects), which was adjusted using the PROC MIXED procedure of the SAS® 9.0 software, and Fisher\'s exact test.
RESULTS: Of 1645 patients diagnosed with PCM, 40 (2.4%) had EHC. Of these, 20 (50.0%) lived in the rural area and 29 (72.5%) were men, with a mean age of 27.1 years (3-65 years). Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients (40.0%), and a mass in the head of the pancreas was observed in 8 (20.0%). The etiological diagnosis was made by tissue collection during surgery in 4 cases (10.0%) and by endoscopic methods in 3 cases (7.5%). Twenty-seven patients (67.5%) received drug treatment alone (Group 1), whereas 13 (32.5%) underwent endoscopic and/or surgical procedures in combination with drug treatment (Group 2). EHC was significantly reduced in both groups (40.7% in Group 1, with a mean time of 3 months; and 38.4% in Group 2, with a mean time of 7.5 months), with no statistically significant difference between them. EHC recurrence rates, associated mainly with treatment nonadherence, were similar in both groups: 37% in Group 1 and 15.4% in Group 2. The mortality rate was 18.5% in Group 1 and 23% in Group 2, with survival estimates of 71.3% and 72.5%, respectively, with no statistically significant difference.
CONCLUSIONS: Although PCM-related EHC is rare, it needs to be included in the differential diagnosis of malignancies, as timely treatment can prevent hepatic and extrahepatic sequelae.