颈淋巴结核术后复发的影响因素

Retrospective analysis of influencing factors for postoperative recurrence of cervical tuberculous lymphadenitis

目的观察负压引流在颈部淋巴结核(CTL)术后的效果及对术后复发因素的分析研究。方法选取河北省胸科医院152例CTL手术治疗的患者为研究对象,并按术后引流方式分为试验组(100例)和对照组(52例)。试验组采用负压吸引的引流方式;对照组采用常规放置引流管的引流方式。比较2组患者术后引流量、术后引流时间、住院时间、换药次数、切口愈合不良发生率、术后复发率等指标。再将152例CTL手术治疗的患者分为复发组23例和无复发组129例,比较2组患者的各项临床资料,采用COX回归分析CTL术后复发的危险因素。结果与对照组比较,试验组患者术后引流量显著增多,术后引流时间、住院时间、换药次数、切口愈合不良发生率和术后复发率均显著低于对照组,差异均有统计学意义(P<0.05);CTL术后复发情况与患者营养状况、术后引流方式、手术淋巴结清扫程度、是否为耐药结核显著相关(P<0.05);多因素Cox分析显示,术后引流方式、手术淋巴结清扫程度、是否为耐药结核为影响CTL术后复发的独立因素(P<0.05)。结论负压引流为更适合CTL术后的引流方式;负压引流、彻底的淋巴结清扫、耐药结核的合理治疗,有利于降低CTL术后复发率。

Objective To observe the effect of negative pressure drainage on cervical tuberculous lymphadenitis(CLT)and to analyze the influencing factors for its recurrence.Methods A total of 152 CTL patients treated in Hebei Chest Hospital were selected as the research objects,and they were divided into experimental group(n=100)and control group(n=52)according to postoperative drainage mode.Negative pressure drainage and conventional drainage were performed in the experimental group and control group,respectively.Postoperative drainage volume,postoperative drainage time,length of stay,times of dressing changes,incidence of poor incision healing,postoperative recurrence rate and other indicators were compared between groups.Then,152 CTL patients were subdivided into recurrence group(n=23)and non-recurrence group(n=129).The clinical data of the two groups were compared,and the risk factors for CTL recurrence were analyzed by COX regression.Results Compared with those of the control group,patients in the experimental group presented significantly higher postoperative drainage volume,shorter postoperative drainage time and length of stay,less times of dressing changes,and lower incidence of poor incision healing and postoperative recurrence rate than those of the control group(P<0.05).The postoperative recurrence of CTL was significantly correlated with the nutritional status,postoperative drainage mode,degree of lymph node dissection,and drug-resistant tuberculosis(P<0.05).Multivariate Cox analysis showed that postoperative drainage mode,degree of lymph node dissection and drug-resistant tuberculosis were independent risk factors for postoperative recurrence of CTL(P<0.05).Conclusion Negative pressure drainage is more suitable for postoperative drainage in CTL patients.Negative pressure drainage,thorough lymph node dissection and rational treatment of drug-resistant tuberculosis are beneficial to reduce the recurrent rate of CTL.