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目的总结儿童淋巴结结核的临床特点和诊疗经验,提高诊疗水平。方法回顾性分析我院2002年1月至2012年12月淋巴结结核患儿的临床资料。结果全部166例病例中,男95例,女71例,平均发病年龄11个月(0~153个月),平均病程1个月(1 d至24个月)。98.80%(164/166)以淋巴结肿大为主诉就诊,临床表现有发热(13.86%)、咳嗽(4.22%)、盗汗(4.82%)、食欲缺乏(4.82%)、体重减轻(1.81%)、乏力(0.60%)。淋巴结主要累及左侧腋下(76/208,36.54%)及左侧颈部(34/208,16.35%),累及单个淋巴结多见(137/166,82.53%)。淋巴结切除病理检查可见朗汉斯巨细胞(88.03%)、干酪样坏死(83.10%)、类上皮细胞(48.59%)。治疗过程中,反常升级反应发生率为18.87%;手术切除+全身抗结核治疗复发率为1.89%。结论儿童淋巴结结核诊断需对临床表现、体征、实验室检查、影像学检查、病理学检查等综合分析,尤其注重病理学检查。治疗上尚无统一共识,推荐采用淋巴结切除术+全身短程抗结核治疗。治疗过程中可能发生反常升级反应。本病应长期随访,全程规则用药,警惕其他部位结核发生的可能。
Objective To summarize the clinical features and diagnosis and treatment experience of pediatric lymph node tuberculosis and to improve the diagnosis and treatment. Methods The clinical data of children with lymph node tuberculosis in our hospital from January 2002 to December 2012 were retrospectively analyzed. Results All 166 cases, 95 males and 71 females, with an average age of onset of 11 months (0 ~ 153 months), the average duration of 1 month (1 d to 24 months). 98.80% (164/166) were complained of lymphadenopathy. The clinical manifestations were fever (13.86%), cough (4.22%), night sweats (4.82%), loss of appetite (4.82%), weight loss Fatigue (0.60%). The lymph nodes mainly involved the left armpit (76/208, 36.54%) and the left neck (34/208, 16.35%). The single lymph node involvement was common (137 / 166,82.53%). Lymphadenectomy showed that Langerhans giant cells (88.03%), caseous necrosis (83.10%) and epithelioid cells (48.59%). During the course of treatment, the incidence of abnormal escalation reaction was 18.87%. The recurrence rate of surgical resection + systemic antituberculous therapy was 1.89%. Conclusion The diagnosis of children with lymph node tuberculosis should be comprehensive analysis of clinical manifestations, signs, laboratory tests, imaging studies, pathological examination, with particular emphasis on pathological examination. There is no consensus on the treatment, it is recommended to use lymphadenectomy + systemic short-course anti-TB treatment. An abnormal escalation reaction may occur during treatment. The disease should be long-term follow-up, the whole rule of the medication, be alert to other parts of the possibility of tuberculosis.