头颈部结核病人的临床特点分析

CLINICAL ANALYSIS ON HEAD AND NECK TUBERCULOSIS

目的：提供对头颈部结核不同临床表现的认识，并探讨其影响诊断的因素。方法：对2000—2003年的66例原发于头颈部结核病人进行回顾性分析。结果：66例病人，56例（85％）为颈淋巴结结核，4例（6％）为喉结核，2例（3％）颈椎结核，2例（3％）中耳结核，口咽结核和咽后脓肿各1例（3％）。30％的病人伴有肺或其它器官的结核；9％的病人有结核病史或为继发的结核。首诊误诊23例，误诊率近35％。结论：对无明显原因的颈部肿块更考虑到结核；针刺细胞学检查是简单有效的诊断方法；喉结核多累及声带，且并非伴有肺结核或痰液阳性；头颈部结核病人应做必要的检查以排除肺结核和其它系统结核；对有结核病史或继发的结核，应做药敏实验以减少多重抗药性。

Objective ： To increase awareness of the different presentations of head and neck tuberculosis （TB） and to discuss its diagnostic difficulties. Methods：A retrospective analysis of patients who presented to us, primarily with TB of head and neck was done from 2000 to 2003. Results： A total of 66 patients presented with primary head and neck TB during the study period. Between them 56 cases （85%） had TB of cervical lymph nodes, 4 patients had laryngeal TB, 2 patients had TB of cervical vertebrae, 2 patients had TB of middle ear, and there was l patient each of oropharynx and retropharyngeal abscess. 30% of cases had associated lung or other organ TB. 9% cases gave history of previous or subsequent TB. 23 cases were misdiagnosis before pathological examination. The overall misdiagnosis rate was 35%. Conclusion：Diagnosing head and neck TB requires a high index of suspicion. Fine needle aspiration cytology （FNAC） is a reliable and easy way to diagnose TB. In the larynx, the vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB. In cases of previous or subsequent TB infection, culture and drug sensitivity is indicated to reduce the problem of multiple drug resistance.