颈部淋巴结结核126例临床分析

目的探讨颈部淋巴结结核的临床特点，提高颈部淋巴结结核的诊治水平。方法对2005年12月至2010年12月在我院确诊并治疗的126例颈部淋巴结结核患者的临床资料进行回顾性分析。结果126例病例中，结节型60例，占47．6％，浸润型27例，占21．4％，脓肿型22例，占17．5％，窦道型17例，占13．5％；合并肺结核58例，占46．0％，局部疼痛53例，占42．1％，咳嗽41例，占32．5％，低热21例，占16．7％，盗汗19例，占15．1％。乏力14例，占11．1％，消瘦15例。6个月疗程组治愈率为60.3％，显效率为39．7％；12个月疗程组治愈率为95．6％，显效率为4．4％。随访2年中，6个月疗程组复发3例，占5．2％。12个月疗程组复发2例，占2．9％。结论颈部淋巴结结核多数不伴有典型的结核病全身中毒症状，易产生误诊、漏诊，应根据淋巴结病理活检、结素试验、结核抗体试验等检查明确诊断，难以确诊者可以诊断性治疗；应重视淋巴结抗酸菌L型感染，避免漏诊；治疗原则与肺结核相同，溃疡型及窦道型可结合局部外科清创或抽脓治疗。疗程应适当延长至1年或以上，以提高治愈率，降低复发率。

Clinical analysis of 126 cases of cervical lymph node tuberculosis

Objective To investigate the clinical characteristics of cervical lymph node tuberculosis, and to improve diagnosis and treatment of ce,＇vical lymph node tuberculosis. Method From December 2005 to December 2010, 126 cases of cervical lymph node tuberculosis in our hospital were diagnosed and treated, whose clinical data was retrospectively analyzed. Results In 126 patients, there were 60 cases of nodular type （47.6%）, 27 cases of infiltrative type （21.4%）, 22 cases of abscess type （17.5%）, 17 cases of sinus type （13.5%）. There were 58 cases of pulmonary tuberculosis （46.0%）, 53 cases of local pain （42.1%）, 41 cases of cough （32.5%）, 21 cases of low-grade fever （16.7%）, 19 cases of night sweat （15.1%）, 14 cases of fatigue （11.1%）, 15 cases of weight loss. The cure rate and effective rate of 6 month course were 60.3%, 39.7% respectively, those of 12 month course were 95.6%, 4.4% respectively. Followed up for 2 years, 3 cases in 6 months treatment group relapsed, accounting for 5.2%; 2 cases in 12 months treatment group relapsed, accounting for 2.9%. Conclusions Most of cervical lymph node tuberculosis is not associated with typical symptoms of systemic poisoning, prone to misdiagnosis. It should be confirmed based on lymph node biopsy, tuberculin test, tuberculosis antibody test and other tests. None confirmed cases should receive diagnostic treatment. L-shaped lymph acid-fast bacterial infection should be paid attention to, avoiding misdiagnosis. Treatment principle of cervical lymph node tuberculosis is identical with tuberculosis, ulcer and sinus type can be combined with local surgical debridement or pumping pus treatment. Treatment should be extended to a year or more, in order to improve the cure rate and lower recurrence rate.