Liver Tuberculosis in Southern Taiwan: 15-years Clinical Experience

台灣南部之肝臟結核感染：15年臨床研究報告

戴維震(Wei-Chen Tai) ； 郭仲謀(Chung-Mou Kuo) ； 李禎祥(Cheng-Hsiang Lee) ； 蔡成枝(Seng-Kee Chuah) ； 黃昭誠(Chao-Cheng Huang) ； 胡琮輝(Tsung-Hui Hu) ； 王景弘(Jin-Hung Wang) ； 曾柏霖(Por-Lin Tseng) ； 張國欽(Kuo-Chin Chang) ； 張簡吉幸(Chi-Sin Changchien)

《內科學誌》 19卷5期 (2008/10) Pp. 410-417

https://doi.org/10.6314/JIMT.2008.19(5).05

摘要

肝臟結核的定義爲肝臟中發現結核分技稈菌感染，通常續發於肺結核或其他器官結核。此回溯性研究的目的在於回顧本院肝臟結核的診斷與治療，並分析臨床表徵、影像學檢查及治療結果。從1992年1月至2006年12月，1251位病人經由病理診斷爲結核菌感染，其中10位病人（5位男性，5位女性）診斷爲肝臟結核。平均年齡爲52.7歲（20~76歲）。臨床症狀包含腹痛(40%)、食慾不振(40%)、噁心或嘔吐(40%)、發燒(30%)及體重下降(20%)。3位病人爲意外發現且無臨床症狀。4位病人爲單獨性肝臟結核，而其他病人有合併出現肝外結核，有4位病人合併肺結核。9位病人的腹部超音波及電腦斷層檢查呈現單發性或多發性肝腫瘤。診斷方法包含超音波指引肝切片(50%)，開腹探查術合併肝切片或肝切除(50%)，肝組織結核菌聚合酵素鏈鎖反應陽性(30%)，抗酸菌染色陽性(20%)。九位病人均接受完整抗結核菌治療並且治癒。總而言之，肝臟結核爲少見但可治癒的疾病。由於無特異性的症狀與多變的影像學表現，診斷肝臟結核是困難的。組織學檢查對於確定診斷此疾病是必要的，但結核菌聚合酵素鏈鎖反應與抗酸菌染色可以提供幫助。肝臟結核經完整抗結核菌治療後通常有良好預後與治療效果。

並列摘要

Liver tuberculosis (TB) is defined as Mycobacterium tuberculosis infections in the liver and is usually secondary from TB of the lung or other organ. The aims of this retrospective study were to review hepatic TB diagnosed and treated in our hospital and analyze the clinical presentations, image studies and therapeutic outcomes. From January 1992 to December 2006, 1251 patients with pathological diagnosis of TB infection were admitted. Among them, ten patients (5 males and 5 females) with the diagnosis of liver TB were enrolled. The mean age of patients with hepatic TB was 52.7 years (20-76 years). The clinical manifestations were abdominal pain (40%), poor appetite (40%), nausea or vomiting (40%), fever (30%), body weight loss (20%). Three patients were found to have hepatic TB infection incidentally without relevant abdominal symptoms. Four patients had isolated hepatic TB and others had extra-hepatic TB infection. Coexistent pulmonary TB was found in 4 patients. Abdominal sonography and computed tomography (CT) in 9 patients revealed solitary liver tumors with or without calcification, or multiple liver tumors. Diagnostic methods included ultrasound-guided liver biopsy (50%), laparotomy and liver biopsy or hepatectomy (50%), positive liver TB-PCR (30%), positive AFB stain (20%). All 9 patients who had received complete antituberculosis therapy were cured of the disease. In conclusion, liver TB is a rare condition but curable disease. The diagnosis of liver TB is difficult due to non-specific symptoms, signs, and variations on image findings. Therefore, determination of histopathology is necessary for definite diagnosis of liver TB supplemented with TB-PCR and AFB stain. Once the diagnosis is confirmed, the disease is usually associated with good prognosis and long-term outcome under complete anti-TB treatment.

並列關鍵字

Liver tuberculosis ； Clinical presentations ； Image studies ； Therapeutic outcomes