纵隔淋巴结结核23例临床分析

Mediastinal Tuberculous Lymphadenitis: A report of 23 Cases

目的 :探讨纵隔淋巴结结核的临床表现特点。方法 :总结自 1982年 4月～ 2 0 0 1年 11月间收治并经手术证实的 2 3例病案。结果 :男性 10例 ,女性 13例 ;年龄 2 1～ 5 9岁 (平均 34.31岁 ) ;均无明显结核中毒症状。肿大淋巴结位于左纵隔 3例 ,右侧12例 ,双侧共同累及 8例。 9例胸部CT观察到环状强化与间隔状强化的表现。接受结核菌素皮试 (PPD)的 2 1例均有不同程度的阳性。术前初诊恶性病变 16例 (6 9.5 7% )、结节病或纵隔良性肿瘤 3例 ,仅 4例拟淋巴结核。本组病例术式为 :剖胸探查活检 11例 ,肺门支气管旁脓肿清除术 2例 ,纵隔镜活检 10例。术后均行抗痨 (2HRZE / 10 - 16HR ) 12～ 18个月后痊愈。结论 :纵隔淋巴结结核常表现为多组淋巴结受累 ,尤以右侧为主 ,肺内并不一定伴有可检出的病灶存在 ;胸CT检查应注重淋巴结在增强扫描前后的密度与形态变化。PPD试验及纤维支气管镜检查对本病诊断有一定的价值。手术是得到病理诊断的方法之一 。

Objective: To investigate the clinical characteristics of mediastinal tuberculous lymphadenitis. Methods: Surgically proved 23 cases, treated between April 1986 and July 2002, were analyzed. Results: There were 10 males and 13 females in this group, aging 21～59 (average of 34.31) years old. No tuberculous toxic syndrome manifested. There were 3 cases of only left mediastinum, 12 of right side, and 8 cases were bilaterally involved. On chest CT, peripheral rim enhancement was seen in 9 cases. PPD tests were performed in 21 cases, and all were positive. Preoperatively, 16 cases (69.57%)were misdiagnosed as malignant diseases, 3 as benign tumors, a total of 4 were correct based on the pulmonary infiltration manifestation. 11 cases underwent exploratory thoracotomy, another 10 cases with mediastinoscopy. All of the patients were successfully treated with intensified anti-tuberculosis treatment (2HREZ/10-16HR). Conclusion:Lymph nodes involved in mediastinal tuberculous lymphadenitis are usually of multi-group, more frequently seen at right side. The density and morphological changes before and after intensification are crucial to CT diagnosis. PPD test and bronchoscopy are of value in certain cases. Surgery is both effective to make pathological diagnosis, and treat related complications. Postoperative anti-tuberculosis therapy should be emphasized.