Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, University of Sydney, Pacific Highway, St Leonards, NSW 2065, Australia.
World J Surg. 2013 May;37(5):984-90. doi: 10.1007/s00268-013-1935-7.
Abdominal tuberculosis (ATB) poses a significant diagnostic, management, and resource challenge. In Australia, an increasing number of tuberculosis (TB) cases are being reported, and we describe our experience of ATB in an Australian tertiary institution.
All diagnosed cases of tuberculosis (TB) at the Royal North Shore tertiary hospital campus of the University of Sydney are entered prospectively into a central registry. Cases of ATB encountered between September 1991 and November 2011 were identified and retrospectively reviewed.
In all, 841 cases of TB were identified, of which 20 were abdominal (2.4 %). Median age at presentation was 34 years (range: 22-79 years), and 55 % of patients were women. None of the patients were born in Australia and 11 patients were of South Asian origin. The most common presenting symptom was abdominal pain (65 %). Diagnosis was based primarily on histology (90 % sensitivity), and the sensitivity of PCR analysis in this series was low (44 %). Eleven of the patients required laparoscopy or laparotomy. 40 % of cases involved the peritoneum, and disease was also seen in solid organs (liver, spleen, pancreas, adrenal gland) and bowel (esophagus, small bowel, colon).
In our local experience ATB was seen exclusively in the immigrant population. The presentation of ATB varies greatly, necessitating a high index of suspicion within the context of abdominal symptoms in high-risk groups. The role of surgical involvement is indispensable for both diagnosis and management of ATB-related complications. Surgeons should remain mindful of the diagnosis in an age of increasing worldwide incidence.
腹部结核（ATB）在诊断、管理和资源方面都存在巨大挑战。在澳大利亚，结核（TB）报告病例数不断增加，我们描述了我们在悉尼大学北岸皇家教学医院的 ATB 诊治经验。
悉尼大学北岸皇家教学医院的所有结核病例均被前瞻性纳入中央登记系统。我们回顾性分析了 1991 年 9 月至 2011 年 11 月期间遇到的所有 ATB 病例。
共发现 841 例结核病例，其中 20 例为腹部结核（2.4%）。中位发病年龄为 34 岁（范围：22-79 岁），55%的患者为女性。没有患者出生在澳大利亚，11 例患者为南亚裔。最常见的首发症状是腹痛（65%）。诊断主要基于组织学（敏感性 90%），本研究中 PCR 分析的敏感性较低（44%）。11 例患者需要腹腔镜或剖腹手术。40%的病例累及腹膜，病变也可见于实体器官（肝、脾、胰腺、肾上腺）和肠道（食管、小肠、结肠）。
在我们的本地经验中，ATB 仅见于移民人群。ATB 的表现差异很大，因此在高危人群出现腹部症状时，需要高度怀疑该病。手术在诊断和治疗 ATB 相关并发症方面都发挥了不可或缺的作用。在全球发病率不断增加的情况下，外科医生应始终牢记该病的诊断。
