Gyan Burman Liver Unit, Department of Surgical Gastroenterology and Liver Transplantation, Room no 3364, Third floor, Casualty Block, Sir Ganga Ram Hospital, New Delhi, 110060, India.
J Gastrointest Surg. 2011 Dec;15(12):2172-7. doi: 10.1007/s11605-011-1685-5. Epub 2011 Oct 1.
Most western patients who have not had a previous operation and present with biliary obstruction are thought to have a malignant lesion. However in our country where the disease is common, we found that some of these patients had a tuberculous cause which considerably altered their management as well as their prognosis. We herein present our experience of these patients whom we had operated with a preoperative diagnosis of biliary tract malignancy and discuss, retrospectively, how they might have been detected before operation to have tuberculosis.
Between August 1996 and June 2010, we operated on 209 patients with a preoperative diagnosis of carcinoma of the gallbladder and common bile duct. Seven out of these 209 patients had biliary tuberculosis. We retrospectively analyzed the clinical features of these patients from our prospectively maintained database.
There were four males and three females who had a mean age of 54 (32-65) years. The bile duct was involved in four and gallbladder in three patients. In contrast to those with malignancy, patients with tuberculosis had a longer history (122 vs 44 days), an abdominal mass was present less frequently (28% vs 57%), the serum bilirubin was lower (1.6 vs 6 mg/dl), and they also had evidence of tuberculosis elsewhere in the body (28.5%). There was no operative mortality in biliary tract tuberculosis in contrast to 7.5% in biliary tract malignancy.
Though tuberculosis of the biliary tract is rare, it needs to be considered in the differential diagnosis of patients with biliary obstruction especially in countries where the disease is endemic.
大多数未曾接受过手术且出现胆道梗阻的西方患者被认为患有恶性病变。然而，在胆道疾病高发的我国，我们发现其中一些患者的病因是结核，这极大地改变了他们的治疗方案和预后。我们在此报告了我们对这些患者的手术经验，这些患者术前诊断为胆道恶性肿瘤，我们回顾性地讨论了如何在术前发现这些患者可能患有结核病。
1996 年 8 月至 2010 年 6 月，我们对 209 例术前诊断为胆囊和胆总管癌的患者进行了手术。这 209 例患者中有 7 例为胆道结核。我们从前瞻性维护的数据库中回顾性分析了这些患者的临床特征。
这 7 例患者中有 4 名男性和 3 名女性，平均年龄为 54 岁（32-65 岁）。4 例患者胆管受累，3 例患者胆囊受累。与恶性肿瘤患者相比，结核患者的病史更长（122 天 vs 44 天），腹部肿块的发生率较低（28% vs 57%），血清胆红素水平较低（1.6 毫克/分升 vs 6 毫克/分升），且患者身体其他部位也有结核病证据（28.5%）。胆道结核患者无手术死亡病例，而胆道恶性肿瘤患者的手术死亡率为 7.5%。
尽管胆道结核很少见，但在胆道梗阻患者的鉴别诊断中需要考虑到该病，尤其是在疾病流行的国家。
