颈部淋巴结结核伴脓肿形成95例临床分析  

Clinical analysis of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation

作　　者：宗华[1] 秦杰[1] 李红春[1] 朱立元[1] 

机构地区：[1]深圳市第三人民医院普外科,广东深圳518000

出　　处：《中国感染与化疗杂志》2018年第1期22-25,共4页Chinese Journal of Infection and Chemotherapy

基　　金：深圳市卫生计生系统科研项目(201402035)

摘　　要：目的探讨颈部淋巴结结核伴脓肿形成患者的临床特点以及外科治疗方法。方法回顾2012年2月-2014年5月深圳市第三人民医院收治的95例颈部淋巴结结核伴脓肿形成患者的临床资料和诊疗过程。结果 95例患者平均年龄(27.8±8.2)岁,中位发病时间4.0个月,以颈部Ⅳ区病变高发;其中34例患者合并肺结核,26例有颈部淋巴结结核手术史。65例患者行脓肿切开引流术和伤口换药处理,22例行脓肿清除、病灶清扫和伤口一期缝合术,8例行溃疡、窦道清除和病灶清扫术。脓肿切开引流术和伤口换药处理平均伤口愈合时间(2.11±1.76)个月,其中18例患者伤口愈合后又再次破溃形成溃疡;另两种外科处理方式中除2例患者术后创面较大,于第1次手术后1个月再次手术行皮瓣转移后愈合,其余患者伤口术后均一期愈合。结论颈部淋巴结结核伴脓肿形成有其特殊的诊疗特点,外科治疗可以根据不同的情况采取不同的措施,多能获得较好的疗效。Objective To explore the clinical features and surgical treatment of cervical tuberculous lymphadenopathy associated with abscess formation. Methods The clinical data of 95 cases of cervical tuberculous lymphadenopathy associated with abscess formation were reviewed and analyzed retrospectively. All the patients were treated in Shenzhen Third People＇s Hospital during the period from February 2012 to May 2014. Results The mean age of the 95 patients was（27.8±8.2） years. The average duration of the disease was 4.0 months. The tuberculous lymphadenopathy was most frequently found in Level Ⅳ cervical lymph nodes. Thirtyfour patients were complicated with pulmonary tuberculosis. History of surgical treatment for tuberculous cervical lymphadenopathy was reported in 26 cases. Sixty-five patients were managed with incision and drainage plus dress changing. Twenty-two patients underwent abscess rinsing, excision and primary wound closure. And 8 patients received excision of ulcers and sinuses, and lymphadenopathy cleaning. The average healing time was（2.11±1.76） months for incision and drainage. Abscess and ulcer reoccurred in 18 of the 65 patients after healing completely by incision and drainage. All the patients treated by the other two surgical modalities were cured as primary healing except 2 patients, who received local flap grafting after primary surgery. ConclusionsCervical tuberculous lymphadenopathy associated with abscess formation has special features in diagnosis and treatment. Surgical approach is usually effective if optimized for individual patients.

关 键 词：颈部淋巴结结核 手术 脓肿形成 外科治疗 

分 类 号：R522[医药卫生—内科学]