Gallbladder cancer management impacted by coexistent tuberculosis.
Gallbladder cancer management impacted by coexistent tuberculosis.
复制标题
胆囊癌的治疗受到共存结核病的影响。
DOI：
10.7869/tg.2012.103
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
A. Agarwal
中科院分区：
文献类型：
--
作者：
A. Javed;A. Arora;R. Kalayarasan;P. Sakhuja;A. Agarwal
背景
在流行地区，胆囊癌（GBC）和结核病可能共存。本研究旨在确定合并结核病对GBC患者管理的影响。
方法
从前瞻性胆囊癌数据库中分析了2003年1月至2007年12月期间在我们中心管理的合并结核病的确诊胆囊癌患者的数据，以突出管理问题，并确定合并结核病对这些患者结局的影响。
结果
在我们中心评估的340例GBC患者中，7例合并结核病，构成研究组。所有患者均为女性（平均年龄56.3岁）。最常见的临床症状为腹痛、食欲减退和体重明显减轻。2例患者在左锁骨上淋巴结细针穿刺细胞学术前评估时发现结核病; 3例患者在术中检测到（1例在分期腹腔镜检查时发现腹膜结核，2例在口腔静脉间淋巴结取样时发现结核性淋巴结炎），2例术后组织病理学检查发现GBC伴肝十二指肠淋巴结结核性淋巴结炎。这7例患者中有6例接受了根治性手术，1例接受了外科搭桥术。
结论
7例GBC合并结核病患者中有5例未进行术前/术中活检确认，可能无法接受根治性手术。因此，在将癌症标记为转移性癌症并剥夺患者治愈的机会之前，必须进行组织病理学确认。
BACKGROUND
In endemic areas, gallbladder cancer (GBC) and tuberculosis may coexist. This study aimed to ascertain the impact of coexistent tuberculosis on the management of patients with GBC.
METHODS
Data of patients with proven GBC with coexistent tuberculosis managed at our centre between January 2003 and December 2007 were analysed from a prospective gallbladder cancer database to highlight the management issues and ascertain the impact that coexistent tuberculosis had on the outcome in these patients.
RESULTS
Of the 340 patients of GBC evaluated at our centre, 7 patients had concomitant tuberculosis and constituted the study group. All the patients were women (mean age 56.3 years). The commonest presenting symptoms were abdominal pain, decreased appetite and significant weight loss. Two patients were found to have tuberculosis on preoperative evaluation on a fine-needle aspiration cytology from the left supraclavicular lymph nodes; 3 patients were detected intraoperatively (1 had peritoneal tuberculosis on staging laparoscopy and 2 had tubercular lymphadenitis on interaortocaval lymph node sampling) and 2 were detected postoperatively with histopathological examination showing GBC with tubercular lymphadenitis of the hepatoduodenal lymph nodes. Six of these 7 patients underwent surgery with curative intent and 1 underwent a surgical bypass.
CONCLUSION
Five of the 7 patients of GBC with coexistent tuberculosis could have been denied the chance of curative surgery had a preoperative/intraoperative biopsy confirmation not been done. Thus, histopathological confirmation is mandatory before labelling a cancer as metastatic and denying the patient a chance for cure.