169例颈、锁骨上淋巴结炎与淋巴结核误诊分析  

Misdiagnosed of Neck and Supraclavicular Lymphadenitis as Lymph Nodes Tuberculosis： A Clinical Analysis of 169 Cases

作　　者：胡培安[1] 孙怡芬[1] 仝丽[1] 

机构地区：[1]北京市结核病胸部肿瘤研究所

出　　处：《结核病与胸部肿瘤》2005年第3期199-202,共4页Tuberculosis and Thoracic Tumor

摘　　要：目的通过对96例颈、锁骨上淋巴结炎及73例颈、锁骨上淋巴结核误诊原因分析。提高对两种疾病的鉴别诊断能力。方法对经病理活检证实的96例颈、锁骨上淋巴结炎误诊为淋巴结核及73例淋巴结核误诊为淋巴结炎的两组病人临床特点和误诊原因进行回顾性对比分析。结果两组病人的发病年龄、临床表现、肿大淋巴结发生部位、PPD试验检查结果对比均无显著性差异，但是淋巴结脓肿形成、溃疡瘘管型是淋巴结核的特征。门诊接诊医师对头面部、口腔缺少仔细检查。抗结核治疗对少部分肿大淋巴结炎有效。结论1、误诊原因：①两种疾病的临床特征不典型；②对淋巴结核诊断有意义的脓肿形成及溃疡瘘管型，一些医师认识不足，仍考虑为炎症；③体检不仔细，使一部分局部感染灶漏检造成误诊：④抗结核药物对部分淋巴结炎有效易造成假象误诊为淋巴结核；⑤抗菌、抗结核治疗无效时，未能进一步做其它检查．机械地延续原治疗。2、经验教训：①掌握淋巴结核易形成脓肿及溃疡、瘘管的特点可减少淋巴结核的误诊；②仔细查体，不漏检头面部、口腔的局部感染灶，可减少淋巴结炎的误诊；③对于抗菌、抗结核治疗变化不大或反复变化或增大的淋巴结．应及时做淋巴结病理活检及抗酸染色检查帮助确诊。Objective To improve the differential diagnosis neck and supraclavicular lymphadenitis from supraclavicular lymph nodes tuberculosis who were misdiagnosed, we hope to improve ability of differential diagnosis between these diseases. Method We retrospectively analyzed 73 cases with neck and supraclavicular lymph nodes tuberculosis who had been misdiagnosed as chronic lymphadenitis and 96 patients with neck and supraclavicular lymphadenitis who had been misdiagnosed as tuberculosis. All cases were confirmed by pathological diagnosis. Results There is no significant difference in age, clinical characteristics, region of lesions and results of PPD among two groups. But abscess, ulceration and fist of lymph nodes are characteristic manifesta- tions of lymph nodes tuberculosis. Doctors usually ignored a careful examination of head and mouth. Anti-tubereulosis therapy were effective for some of lymphnoditis cases.Conclusions 1 Reason of misdiagnosis ① Clinical characteristic of these diseases are atypical; ②Some doctors ignore some useful clues, such a abscess, ulceration and fist, which are useful for the diagnosis of tuberculosis;③Careless physical examination lead to fail to find some infectious lesion;④ Anti-tuberculosis therapy is effective for some lymprmoditis; ⑤Mechanically continue anti-bacterial or anti-tubereulosis therapy, even if it is ineffective. 2 Experiences： ①We must remember that lymph nodes tuberculosis is likely to lead to abscess, ulceration and fist; ② A careful physical examination, including infectious lesions of head and mouth could reduce the misdiagnosis of tuberculosis; ③ Some lymph nodes which are ineffective to anti-bacterial and anti-tubereulosis therapy should be confirmed by biopsy and acid-fast stain.

关 键 词：淋巴结炎 结核 淋巴 误诊 颈、锁骨上 淋巴结核 误诊分析 锁骨上 误诊原因分析 抗结核治疗 肿大淋巴结 

分 类 号：R522[医药卫生—内科学] R551.2[医药卫生—临床医学]