17例皮下结核性脓肿患者临床特征分析

Clinical characteristics analysis of 17 cases of skin tuberculosis presenting as abscesses

目的:探讨皮下结核性脓肿患者的临床表现、治疗方案及疾病转归。方法:回顾性分析我院结核科2020年1月至2024年1月期间收治的17例皮下结核性脓肿患者的临床资料,对患者的发病经过、临床表现、治疗情况及疾病预后情况进行描述性分析。结果:6例皮下结核性脓肿患者病灶位于胸壁(35.29%),4例病灶位于颈部(23.53%),部分可见于腹部、肢体、腰部、腹股沟等。局部症状患者居多,多表现为局部疼痛、灼热(47.06%),部分出现全身症状如畏寒发热(23.53%),少数患者无症状仅是触及肿块。17例患者中单纯的皮肤结核占17.65%,皮肤结核合并肺结核占70.59%,合并肺外结核的占64.71%,肺外结核中以骨结核居多。患者结核感染T细胞实验阳性占82.35%;结核菌素实验阳性率占70.59%;脓液结核分子生物学检测阳性占76.47%;患者超敏C-反应蛋白增高者占68.75%;血沉增高者占40%。10例患者内科联合外科手术治疗最终治愈,7例患者抗结核治疗联合脓液穿刺抽液后好转。结论:对于出现皮下肿物尤其是有结核病史的患者应高度警惕皮肤结核,需及时完善肿物结核分子生物学检查、组织活检病理检查等确诊,对于内科治疗效果不佳的经强化抗结核治疗后联合外科手术治疗,提高皮肤结核的治愈率。

Objective:To explore the clinical manifestations,treatment plans,and disease outcomes of patients with subcutaneous tuberculous abscess.Methods:A retrospective analysis was conducted on the clinical data of 17 patients with subcutaneous tuberculous abscess admitted to our hospital from January 2020 to January 2024.The onset process,clinical manifestations,treatment status,and disease prognosis of the patients were described and analyzed.Results:Six patients with subcutaneous tuberculous abscess had lesions located on the chest wall(35.29%),4 lesions located on the neck(23.53%),and some were visible in the abdomen,limbs,waist,groin,etc.Most patients have local symptoms,mostly manifested as local pain and burning(47.06%),some have systemic symptoms such as chills and fever(23.53%),and a few asymptomatic patients only touch the lump.Among the 17 patients,17.65%had simple skin tuberculosis,70.59%had skin tuberculosis combined with pulmonary tuberculosis,and 64.71%had extrapulmonary tuberculosis.Among extrapulmonary tuberculosis,bone tuberculosis was the most common.82.35%of patients with tuberculosis infection showed positive T cell test results;The positive rate of tuberculin test accounted for 70.59%;76.47%of patients with purulent tuberculosis showed positive molecular biology detection;68.75%of patients have elevated levels of hypersensitive C-reactive protein;40%of cases have increased erythrocyte sedimentation rate.Ten patients were cured through internal medicine combined with surgical treatment,while 7 patients improved after drugs treatment combined with pus puncture and drainage.Conclusion:Patients with subcutaneous tumors,especially those with a history of tuberculosis,should be highly alert to skin tuberculosis.It is necessary to timely improve the diagnosis of tumor and tuberculosis by molecular biological examination,tissue biopsy and pathological examination.For those with poor medical treatment effect,the combination of intensive antituberculosis treatment and surgical treatment can improve the cure rate of skin tuberculosis.