癌末病人感染肺外結核的治療與安寧療護──個案報告

The Treatment and Palliative Care for a Terminal Cancer Patient with Extrapulmonary Tuberculosis: A Case Report

結核（tuberculosis, TB）的防治是全球公共衛生所重視的，而惡性腫瘤病人因為免疫機能低下，更容易得到結核病,因此惡性腫瘤的病人如果得到結核病，治療的時機性及必要性是我們所關切的。結核最常影響的器官為肺臟，亦會影響其他器官，為肺外結核（extrapulmonary tuberculosis, EPTB）。肺外結核與肺結核的治療藥物相同，但會因為於不同的部位而治療時間有差異，隔離方式也會不同。本個案為胰臟壺腹癌（ampulla of Vater cancer）的病人，在接受手術時發現腹膜轉移及腹膜結核（peritoneal tuberculosis），因病況惡化，未接受抗結核治療，只接受接觸隔離，後於安寧病房接受緩和治療。惡性腫瘤的病人感染結核，基於感染及疾病控制的考量下，應接受治療；但如果是末期臨終的病人可能必須討論藥物使用、感染控制的問題，以及心理和靈性的照顧。 The prevention of tuberculosis (TB) is an important global public health issue. Patients with malignant diseases are more vulnerable to tuberculosis because of their immunocompromised status. Therefore, for tuberculosis in patients with malignant diseases, the necessity and timing of treatment need to be carefully assessed. While often affecting the lungs, tuberculosis can also spread to the other parts of the body, resulting in extrapulmonary tuberculosis (EPTB). Though medication is basically the same, TB and EPTB differ from each other in terms of treatment duration and isolation method. This was a case of ampulla of Vater cancer. Peritoneal carcinomatosis and peritoneal tuberculosis were found during operation. As her condition deteriorated quickly, the patient received no anti-tuberculosis therapy but was isolated to prevent potential spread from abdominal lesion. The patient was subsequently sent to hospice ward for palliative care. As indicated by the case, for infection and disease control, a patient with a malignant disease and tuberculosis infection should receive anti-tuberculosis therapy. However, if the patient is terminally ill, the medical team should discuss with the family to reach a consensus about the use of medication, the implementation of isolation, and the need for psychological and spiritual care so as to provide the patient with better end-of-life care.