卡介苗性淋巴结结核临床治疗体会

Clinical experiences of managing tuberculous lymphadenitis caused by an inoculation of Bacillus Chalmette-Guerin

目的研究卡介苗性淋巴结结核的临床特点、诊治方法及预后。方法回顾性分析158例卡介苗性淋巴结结核患儿临床资料，男123例，女35例；年龄30d至1岁，其中〈6个月者136例（86．1％）；卡介苗接种在左侧上臂，淋巴结结核发生在左侧腋下或（并）左侧锁骨上149例，卡介苗接种在右侧上臂，淋巴结结核发生在右侧腋下或右侧锁骨上9例。全组均采用手术治疗；术后给予抗结核药物治疗6个月，即同时服用异烟肼和利福平3个月，后改为单服用异烟肼3个月。本组回访病例按照服抗结核药物情况分三组，对照组：47例，未服用抗结核药物；服药工组：38例，同时服用异烟肼和利福平3个月后停药；服药Ⅱ组53例：同时服用异烟肼和利福平3个月改为单服异烟肼3个月后停药。结果本组回访138例，服药工组治愈36（94．7％）例，服药Ⅱ组治愈52（98．1％）例，对照组治愈46（97．9％）例，服药I组、服药Ⅱ组及对照组治愈率与服抗结核药物之间差异无统计学意义（P〉0．05）。结论卡介苗性淋巴结结核主要依据临床特点、病理检查确定诊断，手术是治疗卡介苗性淋巴结结核的最佳方法，其预后与抗结核药物应用可能无关，主要取决于是否完整切除病灶。

Objective To explore the clinical characteristics, diagnostics, therapeutics and prognosis of tuberculous lymphadenitis caused by an inoculation of Bacillus Chalmette-Guerin （BCG）. Methods Retrospective analyses were conducted for the clinical data of 158 cases of tuberculous lymphadenitis after BCG inoculating. There were 123 males and 35 females with an age range of between 30 days and 1 year. 136 of them （86. 1%） are under 6 months. Among them, 149 cases were inoculated on left arm and developed tuberculous lymphadenitis on left armpit or （and） left supraclavicular area. And another 9 cases were inoculated on left arm and tuberculous lymphadenitis appeared on right armpit or （and） right supraclavicular area. All were operated and took anti- tuberculosis drugs for 6 months （both isoniazid and rifampicin for 3 initial months and isoniazid alone for another 3 months）. According to the regimen of anti-tuberculosis drugs, they were divided into 3 groups. Control group took no anti-tuberculosis drugs, medication group Ⅰ received both isoniazid and rifarnpicin for 3 months and medication group Ⅱ took both isoniazid and rifampicin for 3 months and isoniazid alone for another 3 months. Results A total of 138 cases paid a return visit. And 36 cases （94. 74%） in medication group Ⅰ , 52 cases （98. 11%） in medication group Ⅱ and 46 cases （97. 87%） in control group were cured. The differences were insignificant between three parameters （P〉0. 05）. Conclusions A definite diagnosis of tuberculous lymphadenitis caused by BCG inoculation is based upon its clinical characteristics and pathological results. Surgery is an optimal option. The application of anti-tuberculosis drugs may have nothing to do with its prognosis. The prognosis is dependent mainly on whether nidus is completely resected or not.