原发性颈淋巴结结核的临床特征与治疗

目的：探讨原发性颈部淋巴结结核的临床特征和治疗方法。方法：回顾性分析32例原发性颈部淋巴结结核患者的临床资料。32例患者中29例活检前行CT检查，4例行细针穿刺针吸活检确诊，28例行手术病理检查确诊。27例行肿块全部切除或区域性颈部淋巴结清扫术，术后全身抗结核治疗6个月；5例确诊后行常规抗结核治疗1年。结果：CT显示肿块呈均匀或不均匀强化，部分肿块呈融合现象。全部病例治疗后均行随访，手术患者术后切口均Ⅰ期愈合，1例术后抗结核治疗3个月肿块增大，再次手术确诊为颈部淋巴结结核并发鼻咽癌颈部淋巴结转移，转肿瘤科治疗，其余31例患者均无颈部淋巴结结核复发和其他结核病表现。结论：原发性颈部淋巴结结核临床特征发生改变，颈部肿块为首发症状，多数位于颈后三角区。CT检查有助于本病的诊断和鉴别诊断。全身抗结核药物和手术切除淋巴结的联合应用能有效地治疗原发性颈部淋巴结结核。原发性颈部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，防止冷脓肿及窦道形成。

Clinical characteristics and management of primary cervical tuberculous lymphadenitis

Objective:To investigate the clinical characteristics and management of primary cervical tuberculous lymphadenitis.Method:Thirty-two patients with primary cervical tuberculous lymphadenitis were reported, of which four patients were diagnosed definitely by fine needle aspiration cytology, twenty-eight patients were diagnosed definitely by incisional or excisional biopsy. Twenty-nine patients have been examined by computer tomography(CT) before biopsy. Twenty-seven patients got anti tuberculosis therapy for six months after the total masses resection or regional cervical lymph node dissection, while the others got general anti tuberculosis chemotherapy for one year.Result:CT showed the iso-density enhancement or heterogeneous enhancement of the masses. All patients were followed up. After anti tuberculosis therapy for three months, one patient was diagnosed as cervical tuberculous lymphadenitis combined with cervical lymph node metastasis of nasopharyngeal carcinoma and treated by radiotherapy in the department of oncology, the other thirty-one patients had no relapse and other manifestations of tuberculosis.Conclusion:The characteristics of primary cervical tuberculous lymphadenitis have been changed, cervical masses localized mostly to the posterior cervical regions were the first and major clinical symptoms. CT examination will be helpful for the diagnosis and differential diagnosis of such disease. Primary cervical tuberculous lymphadenitis can be treated effectively with combination of standard anti tuberculosis chemotherapy and surgical excision of the cervical lymph nodes. Operations play an important role in the therapy of primary cervical tuberculous lymphadenitis, such as shortening the treatment period, reducing the dosage, noxious and side-effect of drugs and avoiding the forming of abscess or sinus.