Iwai Tomohisa, Kida Mitsuhiro, Kida Yoshiki, Shikama Nobuaki, Shibuya Akitaka, Saigenji Katsunori
Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.
World J Gastroenterol. 2006 Aug 14;12(30):4914-7. doi: 10.3748/wjg.v12.i30.4914.
A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction (PCR) testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage (EBD) tubes and percutaneous transhepatic biliary drainage (PTBD) tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of post-treatment cicatricial stenosis, although it is rare.
一名36岁的菲律宾女性出现尿液变黑和巩膜黄染。内镜逆行胰胆管造影（ERCP）证实肝内胆管扩张，同时显示肝门处肝总管有不规则狭窄。胆管活检组织学检查显示上皮样细胞肉芽肿和干酪样坏死。随后在胆汁的聚合酶链反应（PCR）检测中发现结核杆菌，从而诊断为胆管结核。尽管微生物学治愈得到证实，但患者出现了肝管瘢痕性狭窄。她接受了多次内镜下胆管引流（EBD）管和经皮经肝胆管引流（PTBD）管治疗，6年后狭窄得到纠正。我们报告一例结核性胆管狭窄病例，这种情况需要与更常见的恶性肿瘤仔细鉴别，并且由于治疗后有瘢痕性狭窄的风险，尽管罕见，但需要长期随访。
