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目的对112例新生儿接种BCG后引起腋下淋巴结强反应的临床表现及采用局部治疗效果进行分析评价。方法对2004年1月至2010年12月门诊112例新生儿接种BCG后淋巴结强反应者,根据病变类型分别给予局部热敷、病灶针吸、彻底清创和抗结核药引流条局部治疗,分析疗效。结果 (1)112例腋下局部淋巴结病变分型:增殖硬结型13例,增殖干酪混合型41例,脓肿破溃型47例,外院术后伤口未愈増殖干酪坏死型11例。112例中除外院手术11例外,余101例均未予全身抗结核治疗。(2)112例中58例首诊时取针吸物或脓液标本进行抗酸杆菌涂片和培养,其中涂片阳性18例(31.03%,18/58),培养阳性22例(37.93%,22/58),22例菌株经菌种鉴定其中20例(90.91%,20/22)为牛结核分枝杆菌。(3)13例增殖硬结者均给予局部热敷,其中5例结节缩小,8例结节内见液化;49(41+8)例干酪坏死型均给予结节局部针吸和异烟肼注射剂结节内注射治疗,佐以热敷,均化脓破溃;96(47+49)例脓肿破溃患儿经彻底清创、伤口置异烟肼引流条引流治疗,伤口愈合;11例外院手术后伤口未愈者给予每周1次清创,并置异烟肼引流条引流,伤口愈合。(4)112例随访6个月均无复发。结论新生儿接种BCG后,少数婴幼儿同侧腋下淋巴结会出现异常反应,其中绝大多数形成寒性脓肿并破溃。局部治疗对新生儿接种BCG后淋巴结强反应治疗的效果好、创伤小、风险低、治愈率高,宜予推广。
Objective To analyze the clinical manifestations of the axillary lymph node reaction induced by BCG in 112 newborns and to evaluate the effect of local treatment. Methods From January 2004 to December 2010, 112 newborns from outpatients with strong postoperative BCG lymph node reaction were treated with topical hot compress, focal needle aspiration, complete debridement and topical anti-TB drainage. The curative effect was analyzed . Results (1) 112 cases of subaxillary local lymph node lesion type: proliferative sclerosis in 13 cases, 41 cases of proliferation cheese mixture, abscess rupture in 47 cases, outside the hospital wound healing no cheese necrosis in 11 cases. Among 112 cases, 11 cases were excluded from systemic antituberculous therapy except for 11 cases of hospital operation. (2) Fifty-eight cases in 112 cases were smeared with acid-fast bacilli and needle aspirates or pus samples at the time of first visit. Among them, smear positive was found in 18 cases (31.03%, 18/58), positive in 22 cases (37.93% 22/58). Twenty-two strains were identified by their strains. Twenty of them (90.91%, 20/22) were identified as Mycobacterium bovis. (3) In 13 cases of proliferative induration, local hot compress was given, in which 5 cases of nodules were reduced and 8 cases of nodules were liquefied; 49 (41 + 8) cases of cheese necrosis were given nodules with local acupuncture and isoniazid injection Nodular injection treatment, accompanied by heat, were purulent rupture; 96 (47 + 49) cases of children with abscess ruptured debridement, wound drainage islet treatment of isoniazid drainage, wound healing; 11 cases of hospital surgery Wound hemorrhage were given once a week debridement, and home drainage isoniazid drainage, wound healing. (4) 112 cases were followed up for 6 months without recurrence. Conclusions After infancy BCG, a few infantile ipsilateral axillary lymph nodes will appear abnormal reaction, most of which form cold abscess and rupture. Local treatment of neonatal immunization after BCG strong response to lymph node therapy, trauma, low risk, high cure rate, should be promoted.