耳鼻咽喉及颈淋巴结结核的诊断:对临床表现的分析  

THE DIAGNOSIS OF TUBERCULOSIS IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY: ANALYSIS OF CLINICAL MANIFESTATIONS

作　　者：孙虹[1,2,3] 谭国林[1,2,3] 萧健云[1,2,3] 李舜农[1,2,3] 

机构地区：[1]湖南医科大学第三附属医院耳鼻咽喉科 [2]湖南医科大学附属湘雅医院耳鼻咽喉科 [3]湖南医科大学第二附属医院耳鼻咽喉科

出　　处：《中国耳鼻咽喉颅底外科杂志》1997年第1期1-5,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：总结２６例耳鼻咽喉和颈淋巴结结核，结合文献分析其临床表现的变化和诊断要点，发现与过去相比，其病变程度和局部、全身症状明显减轻；与肺结核的关系不如以前密切；原发性和血行播散性病变的比例增大；局部以肉芽或增殖性病变为主，溃疡或坏死性病变较轻，外观更象恶性肿瘤。在诊断上，熟悉此病临床表现的变迁，提高警惕性，是防止误诊和漏诊的重要方面。病理学检查仍是主要确诊手段；有时需反复多次活检才能确诊。对病理学难以确诊的病例，应做改良抗酸染色（ＩｎｔｅｎｓｉｆｉｅｄＫｉｎｙｏｕｎ，ＩＫ）或免疫组化染色，以检测常规病理学检查不易发现的Ｌ型菌；治疗试验有重要的辅助诊断价值。临床表现发生变迁的原因与结核菌Ｌ型可能有关。Twenty six cases of tuberculosis in the fields of otolaryngology head and neck surgery have been presented In contrast to tuberculosis in the era about 20 or more years ago, the disease have less severe topical lesions and milder general conditions The relation between this series of tuberculosis and pulmonary tuberculosis are not so close than that in the past The proportions of primary lesions in the ears, nose and throat, and of haemotogenous lesions from pulmonary tuberculosis have probably increased As the topical histopathological changes are mainly granulation or hypertrophy other than ulceration or necrosis, they often resemble, in appearance, carcinoma of ears, nose and throat, especially of the larynx The most important thing for making correct and timely diagnosis is having an intimate knowledge of the changed patterns of tuberculosis and paying vigilant attention to the diseases in clinical practice The main diagnostic evidence is still the histopathological findings-repeated biopsy is sometimes needed In case which is difficult to get a firm diagnosis via histopathological examination, it is necessary to use the methods of Intensified Kinyoun and/or immunohistochemical assay for detection of the L-forms of Mycobacterium Tuberculosis. And also, the diagnostic treatment or treatment test is of great valuable in the diagnosis The cause of the changed patterns of these diseases was also discussed

关 键 词：耳鼻咽喉结核 颈淋巴结结核 淋巴结核 诊断 

分 类 号：R529.804[医药卫生—内科学] R522.04[医药卫生—临床医学]