240例颈淋巴结结核的回顾性分析

A clinical review of 240 cases of cervical tuberculous lymphadenitis

目的调查淋巴结结核的临床特征和治疗方法。方法 2014年1至2015年9月在我院综合门诊及专科门诊因结核病就诊并接受治疗的3318名患者中,颈淋巴结核240人,占所有患者的7.2%,回顾性调查临床特征和治疗方法。结果3318名患者结核病患者中,男性1518人,女性1800人,年龄(14-85)岁,平均年龄(58.40±18.18)岁。颈部淋巴结结核占全部淋巴结核的90.6%(240人),结核累及的器官/组织分布如下:仅累及颈部淋巴结190人(79.1%)、其他部位淋巴结20人(8.3%)、肺12人(5.0%)、肺和脊柱6人(2.5%)、胸膜12人(5.0%),240名颈部淋巴结结核患者均在本院接受抗结核药物治疗,药敏试验显示31人(12.9%)耐药,其中6人(2.5%)双重耐药,出现药物副反应的患者45人(18.8),48人因耐药或药物副反应明显而接受病灶清除手术治疗,227名(94.5%)患者治愈,12名(5.0%)患者三个月内肿块增大,诊断为颈淋巴结复发,1名患者因其他疾病死亡。结论淋巴病灶切除术对颈淋巴结结核患者是一种有效的治疗方式,在抗结核药物治疗无效时可考虑实施。

Objective To investigate the clinical characteristics and treatment of cervical tuberculous lymphadenitis. Methods Clinical characteristics and treatment method of 3318 patients hospitalized at our hospital from January 2014 to September 2015 were reviewed retrospectively and 240 cases of them were diagnosed as cervical tuberculous lymphadenitis. Results Ages of patients ranged from 14 to 85 years（average age was 58.40 years）. The range of tuberculosis progression was as follows： 190（79.1%）cases were in only cervical lymph node, 20 cases were in other（axillary, mediastinal, and abdominal） lymph nodes, 12 cases were in lung and vertebrae lumbales, 6 cases were in lung, and 12 cases were in pleural membrane. All 240 patients were initially treated with antituberculous drugs based on guidelines for tuberculosis. In 45 cases, the antituberculous drugs were replaced due to side effects. 25 cases were involved a single drug-resistant strain, and 6 case were involved a double drug-resistant strain. 48 patients resistant to chemotherapy were successfully treated through neck dissection. 227 cases（94.5%） were cured by chemotherapy or chemotherapy and surgery. Conclusion Local therapy could prove effective therapy in patients with cervical tuberculous lymphadenitis who showed an inadequate response to drugs. The role of neck dissection in cervical tuberculous lymphadenitis remains an important consideration.