颈部淋巴结结核不同影像学分期患者的手术疗效分析  

Analysis of surgical effect of cervical lymph node tuberculosis patients at different imaging stages

作　　者：任航空 黄广红 赵坚 周婕 牛静静 REN Hang-kong;HUANG Guang-hong;ZHAO Jian;ZHOU Jie;NIU Jing-jing(Department of Surgical,Xi’an Chest Hospital,Xi’an 710061,China)

机构地区：[1]西安市胸科医院外科,710061

出　　处：《中国防痨杂志》2021年第8期838-842,共5页Chinese Journal of Antituberculosis

基　　金：西安市卫生和计划生育委员会卫生科研人才培训项目(J201902023);西安市科技计划项目(2019114613YX001SF038(2))。

摘　　要：目的探讨颈部淋巴结结核不同影像学分期患者的手术疗效,以发现最适合进行手术治疗的期别。方法收集2019年1月至2021年1月于西安市胸科医院住院进行手术治疗,并通过病理确诊的201例颈部淋巴结结核患者。以颈部增强CT进行分期,Ⅰ期组(结节型)48例,Ⅱ期组(浸润型)62例,Ⅲ期组(脓肿型)56例,Ⅳ期组(溃疡型或溃疡瘘管型)35例。测量各组最终愈合伤口的瘢痕长度,观察各组伤口愈合时间及各组伤口愈合后的颈部淋巴结结核复发率。结果Ⅰ期组术后伤口愈合时间为5.00(5.00,5.00)d,愈合后瘢痕的长度为(3.79±0.53)cm,复发率为10.4%(5/48);Ⅱ期组术后伤口愈合时间为10.00(8.75,12.00)d,愈合后瘢痕的长度为(4.43±0.44)cm,复发率为11.3%(7/62);Ⅲ期组术后伤口愈合时间为16.00(12.25,19.75)d,愈合后瘢痕的长度为(5.09±0.65)cm,复发率为26.8%(15/56);Ⅳ期组术后伤口愈合时间为19.00(16.00,22.00)d,愈合后瘢痕的长度为(4.86±0.51)cm,复发率为28.6%(10/35)。四组的比较显示,Ⅱ期组术后愈合时间长于Ⅰ期组,Ⅲ期组术后愈合时间长于Ⅱ期组,Ⅳ期组术后愈合时间长于Ⅲ期组,差异有统计学意义(Z=152.435,P<0.001)。四组间术后愈合瘢痕长度的比较显示,Ⅱ期组术后愈合瘢痕长于Ⅰ期组,Ⅲ期组术后愈合瘢痕长于Ⅱ期组,差异有统计学意义(F=55.887,P<0.001)。四组间术后伤口愈合后颈部淋巴结结核复发率的比较显示,Ⅲ期组与Ⅳ期组明显高于Ⅰ期组和Ⅱ期组,差异有统计学意义(χ^(2)=9.165,P=0.027)。结论颈部淋巴结结核随着分期进展,伤口愈合时间增加,颈部瘢痕长度增长,复发率升高,建议颈部淋巴结结核经过抗结核药物治疗后病变无变化者,尽早行手术治疗。Objective To explore the surgical effect of cervical lymph node tuberculosis patients at different imaging stages,in order to find the most suitable stage for surgical treatment.Methods A total of 201 cervical lymph node tuberculosis patients admitted to Xi’an Chest Hospital and confirmed by pathology were collected from Xi’an Chest Hospital between January 2019 and January 2021.According to results of neck enhanced CT,patients were divided into 4 groups of different stages,which were stageⅠgroup(nodular type,n=48),stageⅡgroup(infiltrative type,n=62),stageⅢgroup(abscess type,n=56),stageⅣgroup(ulcerative type or ulcerative fistula type,n=35).The final length of scar,the healing time and the recurrence rate of cervical lymph node tuberculosis after wound healing in these 4 groups were observed.Results The wound healing time,the length of scar and the recurrence rate in stageⅠgroup were 5.00(5.00,5.00)d,(3.79±0.53)cm and 10.4%(5/48);10.00(8.75,12.00)d,(4.43±0.44)cm and 11.3%(7/62)in stageⅡgroup,16.00(12.25,19.75)d,(5.09±0.65)cm and 26.8%(15/56)in stageⅢgroup,19.00(16.00,22.00)d,(4.86±0.51)cm and 28.6%(10/35)in stageⅣgroup.Comparison of the 4 groups showed that the postoperative healing time in stageⅡgroup was higher than that in stageⅠgroup,the postoperative healing time in stageⅢgroup was higher than that in stageⅡgroup,and the postoperative healing time in stageⅣgroup was higher than that in stageⅢgroup,all the differences were statistically significant(Z=152.435,P<0.001),the scar length in stageⅡgroup was longer than that in stageⅠgroup,the scar length in stageⅢgroup was longer than that in stageⅡgroup,both the differences were statistically significant(F=55.887,P<0.001).The recurrence rates after postoperative healing in stageⅢand stageⅣgroups were significantly higher than those in stageⅠand stageⅡgroups(χ^(2)=9.165,P=0.027).Conclusion Of the cervical lymph node tuberculosis,the wound healing time,the length of scar and the recurrence rate increased as the st

关 键 词：手术 结核 淋巴结 颈 X线影像增强 疗效比较研究 

分 类 号：R653[医药卫生—外科学]