鼻根部木村病误诊分析及文献复习  

Analysis of Misdiagnosis of Kimura's Disease at the root of the Nose and Literature Review

作　　者：丁文娟[1] 刘龙燕 南书玲[1] 段世宏[1] 郭玉芬[1] DING Wenjuan;LIU Longyan;NAN Shuling;DUAN Shihong;GUO Yufen(Department of Otolaryngology-Head and Neck Surgery,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院耳鼻咽喉头颈外科,兰州730030

出　　处：《临床误诊误治》2025年第9期14-20,共7页Clinical Misdiagnosis & Mistherapy

基　　金：甘肃省青年科技基金计划项目(21JR11RA119)。

摘　　要：目的 探讨以复发性鼻部肿物为首发症状并误诊为血管瘤的木村病临床特点,增加对此病的认知以提高首次诊断率,降低误诊率。方法 回顾性分析2024年1月收治的1例曾误诊的木村病患者的临床资料,并对相关文献进行复习。结果 患者以复发性鼻背部皮下无痛性肿块为主要临床表现,外周血嗜酸粒细胞绝对值及百分比正常,B超检查提示血管瘤,通过2次鼻部肿物手术切除,最终经病理学检查诊断为木村病。从首次发病诊断为淋巴组织增生到二次复发后确诊,误诊时间长达3年余,预后良好,随访1年无复发。结论 木村病临床罕见,易误诊。组织病理学检查是该病诊断的金标准,影像学检查和血清IgE水平、外周血嗜酸粒细胞绝对值及百分比可协助诊断,手术切除是诊断及治疗的一种有效手段,血常规、尿常规、肾功能检测、血清IgE水平、局部超声检查可以作为随访过程中的监测指标,为后期治疗方案的制定提供参考。Objective To investigate the clinical characteristics of Kimura's disease(KD) with recurrent nasal mass as the initial symptom and misdiagnosed as hemangioma,to increase the awareness of this disease,so as to improve the initial diagnosis rate and reduce the misdiagnosis rate.Methods The clinical data of a patient with misdiagnosed KD admitted to hospital in January 2024 were retrospectively analyzed,and the relevant literature was reviewed.Results The main clinical manifestations of the patient were recurrent subcutaneous painless mass in the back of the nose.The absolute value and percentage of eosinophils in the peripheral blood were normal.The patient was diagnosed as hemangioma by B-ultrasound,and was finally diagnosed as KD by pathological examination after two operations for tumors in the nose.From the initial diagnosis of lymphadenosis to the diagnosis after a second recurrence,the misdiagnosis lasted more than 3 years,the prognosis was good,and there was no recurrence at 1-year follow-up.Conclusion KD is rare in clinical practice and prone to misdiagnosis.Histopathological examination is the gold standard for the diagnosis of KD.Imaging examination,serum IgE level,absolute value and percentage of eosinophils in peripheral blood can assist in diagnosis.Surgical resection is an effective means for diagnosis and treatment,and blood routine,urine routine,blood kidney function testing,serum IgE levels,and local ultrasound examination can serve as monitoring indicators during the follow-up process,providing reference for the formulation of later treatment plan.

关 键 词：鼻部肿物 木村病 误诊 鼻肿瘤 嗜酸粒细胞增多性血管淋巴样增生 病理学 嗜酸粒细胞 

分 类 号：R651[医药卫生—外科学]