近年喉结核的临床病理特征

Clinical and pathological features of laryngeal tuberculosis in recent years

目的探讨近年喉结核的临床病理特征。方法回顾性分析48例喉结核患者的临床病理资料。结果患者以男性多见,男女之比为2.2∶1,中位年龄46.5岁。患者均因喉部症状就诊,声嘶为最常见症状,肺部症状及全身症状少。发病部位以声带最常见(64.6%),其次是会厌(31.3%)和室带(25.0%)。肉眼病变以肥厚性或外生性为主,溃疡性病变多发生在会厌和杓区。组织学病变以增生为主型多见(87.5%),坏死为主型及混合型少见。多数标本含菌量较少,菌体多分布于肉芽肿的类上皮细胞及多核巨细胞的胞质内。结论近年喉结核临床表现多不典型,其感染途径可能已发生改变。临床医师对非特异性喉部病变进行诊断时应考虑到喉结核的可能性,显微镜下应注意该病与喉部其他肉芽肿性疾病的鉴别。

Objective To investigate the clinical and pathological features of recent laryngeal tuberculosis. Methods 48 archived cases of laryngeal tuberculosis treated at our hospital from January 1995 to June 2006 were reviewed retrospectively. Results The results showed a male predominance by 2.2 to 1 and a median age of 46.2 years. All the patients consulted at ENT unit for laryngeal symptoms. The predominant presenting symptom was hoarseness, pulmonary symptoms and constitutional symptoms were relatively rare. Vocal cords were the most common sites affected, followed by epiglottis and ventricular cords. In the majority of cases, the lesion was hypertrophic or even exophytic, and ulcerous lesion was mainly detected at epiglottis and arytenoids. Histologically, cases were mainly proliferative dominant type of which the lesions were mostly granulomatous, and necrotic dominantly type or mixed type were rare. In majority of cases just a small quantity of acid-fast bacteria were detected, and they were mostly found in the cytoplasm of epithelioid cells and that of Langhans giant cells. Conclusion In contrast to earlier studies, the clinical manifestions of laryngeal tuberculosis are atypical, and its transmission path may have changed. Otolaryngologyists need to consider the possibility of this disease when making diagnosis for unspeciffic laryngeal lesions, and pathologists should pay attention to the differential diagnosis of tuberculosis and other laryngeal granulomatous diseases under microscope.