腹膜結核病模仿惡性腫瘤併腹膜轉移

Peritoneal tuberculosis mimicking peritoneal carcinomatosis

人類的結核病 (tuberculosis, TB) 通常由結核分枝桿菌 (mycobacterium tuberculosis)所引起，並局限於呼吸道系統，但仍可涉及任何器官系統，尤其在免疫功能低下的患者身上。如果結核感染侵犯肺實質以外的器官，則稱為肺外結核 (extrapulmonary TB, EPTB)。據目前全球統計，估計10-25% 結核感染屬肺外結核（台灣，肺結核與肺與外結核的比例約9：1）。肺外結核中約15% 為高致命性的，最常見肺外結核的感染部位是淋巴結 (26%)、胸膜 (21%)、散播性結核 (disseminated tuberculosis)(20%) 和中樞神經系統或腦膜 (16%)，因此，建立明確的診斷是非常重要的。原發性腹膜結核病是罕見的疾病，患者常因為非特定性的症狀及臨床檢查（放射影像學及實驗室檢查結果）而被誤診為惡性腫瘤併腹膜轉移 (peritoneal carcinomatosis)，故許多患者仍需要手術以獲取病灶標本作進一步的耐酸性染色 (acid fast stain, AFS)、結核分枝桿菌培養 (TB culture) 及組織學分析才能確診。有見及此，以微創腹腔鏡診斷腹膜結核是相當有效且具有價值的。

Tuberculosis (TB) is an infectious disease that is caused by Mycobacterium tuberculosis and usually confined to the respiratory system but may involve any organ system, particularly in immunocompromised patients If TB infection is not primarily located in the lungs, it is called extrapulmonary TB (EPTB). Worldwide, it is estimated that between 10 to 25% of TB infections occur extrapulmonarily. The most common sites of EPTB were lymph node (26%), pleural (21%), disseminated (20%) and central nervous system (CNS) or meningeal (16%). All-cause highly mortality rate in patients with extrapulmonary TB was 15%. Therefore, establishing a definitive diagnosis is prime importance. Primary peritoneal tuberculosis is a rare disease that may mimic peritoneal carcinomatosis because of non-specific symptoms and similar clinical pictures, including radiologic and laboratory test results, a positive culture or histologic analysis of biopsy specimens is still required in many patients for definitive diagnosis. Accordingly, minimally invasive diagnostic laparoscopy of peritoneal tuberculosis is effective and valuable.