颈部淋巴结核治疗的外科术式选择  

The surgical options of cervical tuberculous lymphadenitis

作　　者：李忠万[1] 李劲松[1] 廖修富 李晓晓[1] 方红雁[1] 

机构地区：[1]重庆市第三人民医院耳鼻咽喉头颈外科,重庆400014

出　　处：《临床耳鼻咽喉头颈外科杂志》2015年第13期1190-1193,1212,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:分析颈部淋巴结核的临床特征及变化特点,探讨颈部淋巴结核治疗的有效外科术式。方法:回顾性分析2008-01-2013-12期间27例颈部淋巴结核患者的临床资料。术前行增强CT检查进行分型,并结合患者临床特点行术前评估,对Ⅰ型颈部淋巴结核患者采用淋巴结切取活检术;对于Ⅱ型及Ⅰ加Ⅱ混合型患者采用病灶切除术;对于Ⅲ型、Ⅳ型及其混合型患者,采用区域性颈淋巴结清扫术。术后放置负压引流球,5%聚维酮碘溶液冲洗术腔,伤口愈合后行抗结核治疗。结果:127例患者左侧发病占63.0%,右侧占25.9%,双侧占7.4%,中线占3.7%;病变累及1个区域以上者占多数(62.1%),累及1个区域占37.9%,Ⅴ区受累最为多见(69.0%),随后依次为Ⅳ区(62.1%)、Ⅲ区(51.7%)、Ⅱ区(34.5%)、Ⅰ区(10.3%)、Ⅵ区(3.4%)。2分析CT影像学特点,单纯型占多数(65.5%),以Ⅲ型(24.1%)最常见,随后依次为Ⅰ型(17.2%)、Ⅱ型(13.8%)、Ⅳ型(10.3%);混合型较少,占34.5%,其中2种方式同时存在较多(31.0%),3种方式同时存在仅1侧(3.4%)。所有患者经手术切除及规范性抗结核治疗后均未出现复发。结论:对于颈部淋巴结核,应根据病变特点、部位和CT影像学表现进行术前评估,选择适合的外科术式。术后予以负压引流,5%聚维酮碘溶液冲洗术腔,并行抗结核治疗,是治疗颈部淋巴结核的有效方法。Objective：To analyze the clinical features variation features of cervical tuberculous lymphadenitis and to discuss its effective surgical treatment.Method：Retrospective analysis of 27 cases of cervical tuberculous lymphadenitis patients admitted to the hospital from January 2008 to December 2013.The cervical tuberculous lymphadenitis is classified based on the enhanced CT scanning conducted before operation and the preoperative evaluation of clinical characters of patients.The lymphaden ncisional biopsy was conducted on the typeⅠ patients with cervical tuberculous lymphadenitis.The lesion resection was performed on the typeⅡ and mixed typeⅠ＋Ⅱ patients.The regional cervical lymph node dissection was carried on the type Ⅲ,the type Ⅳ and other mixed type patients.The negative pressure drainage ball was placed after operation,and the cavity was flushed with 5% povidone iodine solution.The antituberculosis therapy was performed after wound healing.Result：The analysis of the clinical features for 27patients：the incidence rate on the left side,right side,both sides and middle-line is63.0%,25.9%,7.4% and 3.7% respectively.The majority of patients whose lesion involving more than one region account for 62.1%;the patients whose lesion involving one region account for 37.9%.The most common is levelⅤ involved lesion（69.0%）,then levelⅣ（62.1%）,levelⅢ（51.7%）,levelⅡ（34.5%）,levelⅠ（10.3%）and levelⅥ（3.4%）in order.The analysis of the CT imageology features for 27patients：the simple type is the majority（65.5%）,and the most common is typeⅢ（24.1%）,then the typeⅠ（17.2%）,typeⅡ（13.8%）and typeⅣ（10.3%）in order.The mixed type is minority（34.5%）,but the two mixed is often（31.0%）.The three mixed is only located on one side（3.4%）.The recurrence never happened on the patients with resection and standard antituberculosis therapy.Conclusion：For the cervical tuberculous lymphadenitis,the suitable surgical treatments shall be selected according to t

关 键 词：颈部 结核 淋巴结炎 治疗 

分 类 号：R529.8[医药卫生—内科学]