肝十二指肠韧带淋巴结结核误诊为胰头肿瘤一例

患者女,33岁.因右上腹隐痛伴后背部胀痛20余天入院.腹痛呈持续性隐痛,夜间明显,与进食、体位无关,无纳差、乏力、消瘦、发热、咳嗽、咳痰、盗汗等症状.小便色黄.既往无高血压、糖尿病、冠心病、肝炎等病史.10年前患右侧颈部淋巴结结核,予手术切除,未行抗结核治疗.5年前再次出现左侧颈部淋巴结结核,抗结核治疗半年.体检:巩膜轻度黄染,全身皮肤无出血点及皮疹,浅表淋巴结未及,右侧颈部可见一长约3 cm的手术瘢痕.心肺无异常.     

外科手术治疗颈部淋巴结结核的临床效果观察

目的观察外科手术治疗颈部淋巴结结核的临床效果。方法对2001年1月—2012年1月我院收治的107例颈部淋巴结结核患者进行外科手术,对患者体内病灶进行彻底清除,局部加压包扎,全身辅助抗结核治疗。结果患者切口Ⅰ期愈合者97例,愈合率为90.7%;其他10例患者换药两周后愈合,平均愈合时间为8d。结论外科手术治疗颈部淋巴结结核疗效理想,患者切口愈合快,值得在基层医院推广。     

颈部淋巴结结核外科治疗并发症的危险因素分析

目的对颈部淋巴结结核外科治疗并发症的危险因素进行分析。方法回顾分析我院外科收治的179例颈部淋巴结结核患者,分析年龄、体重指数、病灶大小、受累淋巴结的分区、是否并发糖尿病以及是否存在耐多药等临床资料与手术并发症的相关性。结果性别、年龄、体重指数、糖尿病与手术并发症无相关性(P0.05),病灶CT横截面直径≥3cm手术并发症发生率是3 cm的4.641倍,淋巴结受累达到2组及以上手术并发症发生率是受累1组的4.060倍,耐多药(+)手术并发症是耐多药(-)组的5.594倍;结论病灶直径≥3cm、受累淋巴结区域≥2个及耐多药(+)显著增加颈部淋巴结结核手术并发症发生率,是手术并发症的危险因素。     

颈部淋巴结结核致皮肤-淋巴结-咽瘘一例

<正>颈部淋巴结结核是常见的肺外结核之一,占淋巴结结核的80%～90%~([1])。其临床症状不典型,早期多表现为逐渐增大的无痛性肿块,若诊治及时,大部分患者经正规抗结核药品治疗均可治愈~([2]),但仍有10.1%～31.6%的患者病情进展,形成局部脓肿、皮肤破溃、瘘道形成,或肺门纵隔淋巴结结核致淋巴结-支气管瘘,需要较长时间引流方能愈合~([3])。而颈部淋巴结结核导致皮肤_淋巴结_咽瘘鲜见报道。笔者对上海市公共卫生临床中心收治的1例因颈部淋巴结结核导致皮肤-淋巴结-咽瘘患者进行报道,旨在为临床工作提供借鉴。     

颈部淋巴结结核的超声表现

目的分析颈部淋巴结结核的超声特点,以提高超声诊断率。方法分析123例经手术或淋巴结穿刺活检确诊为颈部淋巴结结核的病例资料,对其超声表现进行分析、讨论。结果颈部淋巴结结核具有较典型的声像特点,表现为病灶数目多,呈串珠状排列,常融合成团以及内部回声呈多样性表现。结论根据声像特点并结合临床表现进行综合分析能较准确地诊断颈部淋巴结结核,超声可作为该疾病的首选检查方法。     

133例颈淋巴结结核的疗效观察

颈部淋巴结结核临床最为多见，由于受累淋巴结深浅不一，多有反复感染，治疗效果不佳。我所自1994年10月至1999年1月用内服外用的方法治疗颈淋巴结结核133例，均取得较满意疗效．现报告如下：     

猫爪草胶囊治疗颈部淋巴结结核204例临床分析

目的 分析猫爪草胶囊治疗颈部淋巴结结核的效果。方法 对204例病人随机分为两组：对照组常规应用异烟肼、利福平、链霉素、吡嗪酰胺抗结核治疗；治疗组在上述治疗的基础上加用猫爪草胶囊。结果 治疗组的临床治愈例数明显高于对照组，疗程明显缩短。结论 猫爪草胶囊＋抗结核药物治疗颈部淋巴结结核，有缩短疗程、提高疗效的作用，且没有毒副作用。     

解毒散结汤治疗瘰疬60例疗效观察

西医将瘰疬称之为颈部淋巴结结核,祖国传统医学认为其病因为热毒痰核互结而致。1993～1999年,我院采用自拟解毒散结汤治疗本证患者60例,取得较好疗效,现报告如下。 一般资料:本组60例患者中,男12例,女48例;年龄16～47岁,平均31岁。全部病例均以颈部淋巴结肿大为主诉就诊,其中双侧颈部淋巴结肿大35例,颈部及颌下淋巴结肿大10例,颈部及耳后淋巴结肿大5例,单侧淋巴结肿大10例。患处均有压痛。39例患者有结核病史,42例患者结核菌素试     

中西医结合治疗周围淋巴结结核疗效观察

周围淋巴结结核,好发颈部、腋窝、腹股沟等处,常伴有细胞免疫功能低下。淋巴结结核经抗结核治疗,肿块消失或缩小不理想,破溃后难愈。1997年12月至2000年12月我院采用中西医结合治疗周围淋巴结核126例,取得满意疗效,现报道如下。     

猫爪草胶囊治疗颈部淋巴结结核204例临床分析

目的　分析猫爪草胶囊治疗颈部淋巴结结核的效果。方法 对204例病人随机分为两组:对照组常规应用异烟肼、利福平、链霉素、吡嗪酰胺抗结核治疗;治疗组在上述治疗的基础上加用猫爪草胶囊。结果 治疗组的临床治愈例数明显高于对照组,疗程明显缩短。结论 猫爪草胶囊+抗结核药物治疗颈部淋巴结结核,有缩短疗程、提高疗效的作用,且没有毒副作用。     

病灶清除术治疗颈淋巴结核38例临床分析

目的观察外科病灶清除术治疗巨大脓肿型颈淋巴结核的临床价值。方法对38例临床诊断为巨大脓肿型颈淋巴结核的患者,采用一次性脓肿病灶清除术治疗。结果 38例均临床治愈。其中32例一期缝合者:Ⅰ期愈合30例,Ⅱ期愈合2例;创口敞开6例,25d~45d创口愈合。术后按2HRZE/10HRE方案规范抗结核治疗。随访0.5~1.5年,原手术部位无复发。结论病灶清除术治疗巨大脓肿型颈淋巴结核有重要价值,与分期手术有同等的效果。     

Lymph node tuberculosis: 7-year experience in Veterans General Hospital, Taipei, Taiwan.

We retrospectively studied 71 cases of lymph node tuberculosis confirmed by culture or pathology from 1983 to 1989. Young adults were most frequently involved and the female to male ratio was 3:2. of 71 patients, three-quarters presented with palpable masses and two-thirds were asymptomatic. The cervical nodes were most frequently involved. Roentgenographic evidence of pulmonary tuberculosis was detected in 42% of patients and sputum culture-positive tuberculosis occurred in 7%. Tuberculin skin testing is less useful in our country due to routine BCG vaccination during infancy and early childhood. Selective excisional biopsy in addition to clinical information was necessary for differential diagnosis. 48 patients received regular treatment and were followed up for at least 1 year. Fresh nodes or enlargement of existing nodes developed in 10% of patients during treatment. Residual nodes were present in 10% of patients at the end of 9-month treatment with rifampicin, isoniazid and ethambutol, including prolonged or modified regimens in some individuals. In conclusion, in areas with a high frequency of tuberculous strains presenting a primary resistance to isoniazid, a 9-month regimen of rifampicin, isoniazid and ethambutol is recommended for lymph node tuberculosis.     

Asymptomatic gastric tuberculosis in the gastric body mimicking an isolated microscopic erosion: A rare case report

Introduction:Gastric tuberculosis is rarely seen in clinical practice, which occurs mostly secondary to lung tuberculosis, intestinal tuberculosis, and other common tuberculosis. Gastric tuberculosis rarely presents as a single microscopic superficial erosion. We recently diagnosed such a case, hence reporting it herein.Patient concerns:A 40-year-old female patient was admitted with a chief complaint of painful enlarged cervical lymph nodes. She had no other symptoms or any previous history of remarkable diseases.Diagnosis:Physical examination found multiple enlarged cervical lymph nodes. Computer tomography revealed multiple circular well-defined soft tissue masses in the bilateral carotid sheath spaces. A cervical lymph node biopsy showed caseous necrosis with infiltration of neutrophils and lymphocytes, and most importantly, mycobacteria through staining for acid fast bacilli. Routine gastroscopy showed a 0.5 cm × 0.5 cm well-defined erosion on the large curvature of the gastric body. Gastric biopsy revealed chronic granulomatous inflammation with mycobacteria through staining for acid fast bacilli. The patient was diagnosed as having cervical lymph node tuberculosis and gastric tuberculosis.Interventions and outcomes:She received 6 months of standard anti-tuberculosis therapy. The enlarged cervical lymph nodes shrank in size and the pain was relieved.Conclusions:Gastroscopy should be performed to look for gastric tuberculosis if the patient presents primary tuberculosis in other organs/tissues such as cervical lymph nodes. If any small erosion is found, a biopsy is justified for checking the possibility of gastric tuberculosis.     

Assessment of lymph node tuberculosis in northern Germany: a clinical review

AIM OF STUDY: To evaluate patient profiles, diagnostic approaches, and treatment strategies in patients with lymph node tuberculosis. METHODS: Demographic data, diagnostic findings, and therapies were retrospectively analyzed in 60 patients with lymph node tuberculosis who were hospitalized between 1992 and 1999. RESULTS: Thirty percent (n = 18) of patients were natives, and 70% were immigrants (n = 42). The cervical lymph nodes were most frequently involved (63.3%), followed by the mediastinal lymph nodes (26.7%) and the axillary lymph nodes (8.3%). All patients (except one patient who was HIV-positive) showed a positive response to tuberculin skin testing. Lymph node excision and fine-needle aspiration (FNA) were similarly effective in obtaining sufficient material for histologic and microbiological analysis. Mycobacterium tuberculosis was identified in 43.3% of patients by microbiological testing, and culture methods showed the highest sensitivity. Despite standard treatment, the initial enlargement of the lymph nodes occurred in 20% of patients and local complications occurred in 10%. CONCLUSION: Lymph node tuberculosis is still an important issue in developed countries and has to be considered in differential diagnosis. The best approach appears to be a combination of skin testing and FNA. Negative results in the identification of M tuberculosis do not exclude the diagnosis of lymph node tuberculosis.     

Tuberculous pericardial effusion: features, tamponade, and computed tomography

The clinical features with particular reference to tamponade and mediastinal adenopathy were studied in tuberculous pericardial effusion. Tamponade is a frequent complication and the recognition of tuberculous etiology can be difficult. Involvement of the pericardium is mostly from mediastinal lymph nodes that have not been studied. This was a prospective cohort study. All patients had large effusions, and underwent pericardiocentesis and chest computed tomography. Patients with tuberculosis had specific therapy. Others with viral/idiopathic effusion served as controls for the computed tomography studies. There were 26 patients with tuberculosis: 18 had tamponade on echocardiography. All had symptoms. Fever (n = 23) and dyspnea (n = 20) were the most frequent presenting symptoms. Pericardial rub was heard in 14, and 3 had enlarged cervical or axillary nodes. Pulmonary tuberculosis was present in 6. Tuberculin skin test measured 17 +/- 3.3 mm. The biopsy specimen showed a granuloma in 22 of 24. All 26 had mediastinal lymph nodes > 10 mm with a mean size of 19.5 +/- 8.6 mm that disappeared (81%) or regressed (19%) on treatment (p < 0.001). Aortopulmonary nodes were most frequently enlarged (65.4%) and hilar the least. Three required pericardiectomy. At follow-up all were doing well. None with viral/idiopathic effusion had lymph node enlargement. Fever, dyspnea, and tamponade were frequent with tuberculosis. The prognosis was good with specific therapy. Mediastinal nodes were enlarged in all and only with tuberculosis and not with viral/idiopathic effusion. Nodes disappeared or regressed with treatment. In the appropriate clinical context, mediastinal lymph node enlargement on chest computed tomography along with a strongly positive skin test results could help in the diagnosis of a tuberculous etiology of pericardial effusion.     

Case of liver tuberculosis requiring differentiation from liver metastasis of cancer

A 79-year-old woman was admitted to our hospital because of general fatigue. Chest radiograph and computed tomograph showed bronchiectasis and centrilobular nodules in the right middle lobe and lingula, which had not changed from previous examination. Intrahepatic nodular lesions and swelling of the left cervical lymph nodes, supraclavicular lymph node, abdominal paraaortic lymph nodes and inguinal lymph nodes was observed. Biopsy specimen of the liver lesion demonstrated epithelioid cell granulomas. Biopsy of the right inguinal lymph node demonstrated epithelioid cell granulomas with caseous necrosis and culture of the specimen showed Mycobacterium tuberculosis. The patient was diagnosed as having liver tuberculosis and multiple tuberculous lymphadenitis. Antituberculous treatment with isoniazid, rifampicin, ethambutol and pyrazinamide were started and continued for 6 months. All lesions improved after treatment. This was a rare case of liver tuberculosis that was difficult to distinguish from liver metastasis of cancer.     

Tuberculous dacryoadenitis: a rare manifestation of tuberculosis

A 41-year-old Somalian female inhabitant of The Netherlands presented with malaise and cervical lymph node swelling. Enlarged mediastinal, hilar and abdominal lymph nodes were found on CT scan. Subsequently the left lacrimal gland became swollen, accompanied by periostitis of the lateral orbit margin. Mycobacterium tuberculosis was cultured from lymph node tissue and the diagnosis of tuberculous dacryoadenitis with periostitis was made on CT images and histology. All lesions responded well to tuberculostatic treatment. Although tuberculous dacryoadenitis is a very rare manifestation of tuberculosis, it is still important to recognise this presentation, especially since the incidence of tuberculosis continues to increase in Western countries.     

Gallbladder tuberculosis (case report and review of the literature)

The incidence of abdominal tuberculosis is increasing and the familiarity with its clinical presentation shortens its diagnostic time and improves its management. Gallbladder tuberculosis has unique considerations regarding its pathology, diagnosis and surgical management. The authors report a case of gallbladder tuberculosis in a 40 year-old female who presented with a clinical picture of acute cholecystitis. Abdominal ultrasound showed a dilated gallbladder with a large gall stone located in the neck region. Several lymph nodes were seen in the hilum of the liver compressing the portal vein which were associated with smaller retroperitoneal lymph nodes. The diagnosis of gallbladder tuberculosis was reached only during surgery and was proven by histopathology. The gallbladder was adherent to the surrounding tissues and covered with multiple tuberculous nodules. The patient had a retrograde open cholecystectomy and treated with anti-tuberculous drugs. The literature on this topic is reviewed.     

63例结核性淋巴结炎临床分析

目的分析淋巴结结核患者发病情况、诊断方法和治疗效果。方法回顾性分析2000年4月至2006年4月间63例本院确诊的淋巴节结核病人临床资料。结果颈淋巴结最常见,40例占63．4％。其次为腋下淋巴结结核17例（26．9％）、其它部位6例（9．5％）。多数病人结核菌素试验呈阳性反应。细针针吸活检所获得标本,51例作结核分支杆菌培养检查。18例（18／51）病人分离出结核分枝杆菌,敏感性极高（35．3％）。结论淋巴结结核在我国仍是一个常见病,且以外地民工多见。应充分重视。可采用结核菌素皮肤试验和细针活检术（FNA）相结合,诊断并不困难。     

原发性颈淋巴结结核的治疗体会及Elispot技术的诊断价值

目的 探讨原发性颈淋巴结结核的各种治疗方法的优缺点及评价酶联免疫斑点(Elispot)检测外周血中结核分枝杆菌性抗原特异性γ一干扰素水平在颈淋巴结结核中的诊断价值.方法 回顾分析89例原发性颈淋巴结结核患者的临床资料,30例(A组)采用内科治疗(化疗l～1.5年),28例(B组)行肿块全部切除加区域性颈淋巴结清扫术,16例(C组)行淋巴结结核病灶切除术,15例(D组)行病灶切开刮除、开放引流术,所有手术患者术后均化疗1年.用Elispot技术对患者外周血中产生结核菌抗原特异性γ一干扰素的水平进行定量检测,同时检测患者的结核抗体.结果 A组中22例肿块继续增大并增多(73.3%),其中9例形成脓肿破溃;B组无一例复发;C组5例复发(31.3%);D组3例形成结核性窦道,4例再发淋巴结肿块(46.7%);保守治疗和手术治疗复发率比较有明显统计学差异(χ2=9.69,P<0.01),保守治疗复发率明显升高;三种手术方式复发率比较也有明显统计学差异(χ2=14.47,P<0.01),此4组患者手术愈合时间有统计学差异(F=104.44,P<0.01),B组患者手术愈合时间最短.复发率最低;Elispot、结核抗体检测患者的阳性率分别是87.6%、62.9%(χ2=14.61,P<0.01).结论 原发性颈淋巴结结核的治疗应以手术为主, 手术治疗能缩短治疗时间,减少药物用量及不良反应,能明显提高治愈率.降低复发率,而手术方式首选肿块伞部切除加区域性颈淋巴结清扫术;Elispot技术优于结核抗体,可用于颈淋巴结结核的辅助诊断.