颈部淋巴结结核不同影像学分期患者的手术疗效分析

doi:10.3969/j.issn.1000-6621.2021.08.016

摘要/Abstract

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(χ²=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。

关键词: 手术, 结核,淋巴结, 颈, X线影像增强, 疗效比较研究

Abstract:

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 stage Ⅰ group (nodular type, n=48), stage Ⅱ group (infiltrative type, n=62), stage Ⅲ group (abscess type, n=56), stage Ⅳ group (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 stage Ⅰ group 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 stage Ⅱ group, 16.00 (12.25, 19.75) d, (5.09±0.65) cm and 26.8% (15/56) in stage Ⅲ group, 19.00 (16.00, 22.00) d, (4.86±0.51) cm and 28.6% (10/35) in stage Ⅳ group. Comparison of the 4 groups showed that the postoperative healing time in stageⅡgroup was higher than that in stage Ⅰ group, the postoperative healing time in stage Ⅲ group was higher than that in stage Ⅱ group, and the postoperative healing time in stage Ⅳ group was higher than that in stage Ⅲ group, all the differences were statistically significant (Z=152.435, P<0.001), the scar length in stage Ⅱ group was longer than that in stage Ⅰ group, the scar length in stage Ⅲ group was longer than that in stage Ⅱ group, both the differences were statistically significant (F=55.887, P<0.001). The recurrence rates after postoperative healing in stage Ⅲ and stage Ⅳ groups were significantly higher than those in stageⅠand stage Ⅱ groups (χ²=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 stage progressed. Therefore, surgical treatment was recommended to perform as soon as possible for cervical lymph node tuberculosis patients whose lesion did not change after drug treatment.

Key words: Surgery, Tuberculosis,lymph node, Neck, Radiographic image enhancement, Comparative effectiveness research

任航空, 黄广红, 赵坚, 周婕, 牛静静. 颈部淋巴结结核不同影像学分期患者的手术疗效分析[J]. 中国防痨杂志, 2021, 43(8): 838-842. doi: 10.3969/j.issn.1000-6621.2021.08.016

REN Hang-kong, HUANG Guang-hong, ZHAO Jian, ZHOU Jie, NIU Jing-jing. Analysis of surgical effect of cervical lymph node tuberculosis patients at different imaging stages[J]. Chinese Journal of Antituberculosis, 2021, 43(8): 838-842. doi: 10.3969/j.issn.1000-6621.2021.08.016

图/表 2

表1

图1~12

参考文献 9

[1]	杨贤明, 曾丽翔, 李晓云, 等. 颈部淋巴结结核126例临床分析. 国际医药卫生导报, 2014, 20(6):783-785. doi: 10.3760/cma.j.issn.1007-1245.2014.06.015.
[2]	Perlman DC, D’Amico R, Salomon N. Mycobacterial Infections of the Head and Neck. Curr Infect Dis Rep, 2001, 3(3):233-241. pmid: 11384553
[3]	Ammari FF, Bani Hani AH, Ghariebeh KI. Tuberculosis of the lymph glands of the neck: a limited role for surgery. Otolaryngol Head Neck Surg, 2003, 128(4):576-580. doi: 10.1016/s0194-5998(03)00121-9. doi: 10.1016/S0194-5998(03)00121-9 URL
[4]	王辉, 丁长青, 郝苏荣, 等. 颈部淋巴结结核的MRI表现(附26例分析). 中国CT和MRI杂志, 2015, 13(5):19-22. doi: 10.3969/j.issn.1672-5131.2015.05.007.
[5]	Mrówka-Kata K, Namysłowski G, Czecior E, et al. An updated view on tuberculous lymphadenitis in the context of HIV epidemic as well as multidrug and extensively drug-resistant tuberculosis. Otolaryngol Pol, 2012, 66(3):176-180. doi: 10.1016/S0030-6657(12)70765-5. doi: 10.1016/S0030-6657(12)70765-5 URL pmid: 22748677
[6]	任航空, 段李明, 黄大业, 等. 初治继发性肺结核患者治疗过程中并发颈部淋巴结结核的危险因素分析. 中国防痨杂志, 2020, 42(11):1165-1170. doi: 10.3969/j.issn.1000-6621.2020.11.005.
[7]	任宏宇, 林上奇, 朱敏, 等. 颈部淋巴结结核CT及MRI诊断. 中华全科医学, 2014, 12(5):786-788.
[8]	任荣, 袁功玲, 李敏, 等. 66例颈部淋巴结结核的CT征象分析. 中国防痨杂志, 2018, 40(7):713-718. doi: 10.3969/j.issn.1000-6621.2018.07.009.
[9]	姚岚, 肖和平. 颈部淋巴结结核发生结核性脓肿的危险因素分析. 中国防痨杂志, 2019, 41(1):53-56. doi: 10.3969/j.issn.1000-6621.2019.01.012.

CLT分期	性别[例(构成比,%)]		病灶最大直径 (cm,$\bar{x} \pm s$)		术后伤口愈合时间 [d,M(Q₁,Q₃)]	愈合后瘢痕长度 (cm,$\bar{x} \pm s$)	术后6个月内复发 [例(复发率,%)]
CLT分期	男性	女性	病灶最大直径 (cm,$\bar{x} \pm s$)		术后伤口愈合时间 [d,M(Q₁,Q₃)]	愈合后瘢痕长度 (cm,$\bar{x} \pm s$)	术后6个月内复发 [例(复发率,%)]
Ⅰ期组(48例)	22(45.8)	26(54.2)	3.71±0.54		5.00(5.00,5.00)	3.79±0.53	5(10.4)
Ⅱ期组(62例)	28(45.2)	34(54.8)	3.94±0.66		10.00(8.75,12.00)	4.43±0.44	7(11.3)
Ⅲ期组(56例)	26(46.4)	30(53.6)	3.76±0.77		16.00(12.25,19.75)	5.09±0.65	15(26.8)
Ⅳ期组(35例)	16(45.7)	19(54.3)	3.72±0.52		19.00(16.00,22.00)	4.86±0.51	10(28.6)
统计检验值	χ²=0.019		F=1.589	Z=152.435		F=55.887	χ²=9.165
P值	0.999		0.193	<0.001		<0.001	0.027

[1]	艾雅娟, 韩旭, 毕娜, 余兴艳, 张颖, 张亚茹, 王攀, 罗小波. “三联”放松训练对脊柱结核术后患者疼痛、焦虑情绪及睡眠质量的影响[J]. 中国防痨杂志, 2021, 43(7): 747-750.
[2]	范俊, 董伟杰, 兰汀隆, 唐恺, 李元, 严广璇, 王恒, 秦世炳. 脊柱结核病灶清除术中局部应用凝血酶冻干粉的疗效分析[J]. 中国防痨杂志, 2021, 43(5): 437-440.
[3]	万海方, 陶凡, 赵杰, 陈远辉, 黄焱明, 傅云斌. 老年脊柱结核患者术后发生认知功能障碍的影响因素分[J]. 中国防痨杂志, 2021, 43(5): 441-445.
[4]	章鹏, 费骏, 石仕元, 胡德新, 陈根君, 张晨威, 王敏. 皮质骨轨迹螺钉内固定对老年腰椎结核患者术后康复的影响[J]. 中国防痨杂志, 2021, 43(5): 446-451.
[5]	王倩, 张亚超, 张磊, 雷国华. 加速康复外科理念在脊柱结核围手术期护理中的应用效果[J]. 中国防痨杂志, 2021, 43(5): 463-467.
[6]	苗瑞瑞, 辛士珍, 唐亮, 宁华英, 鲍玉成, 张文龙. 加速康复外科理念指导下的围手术期营养治疗在脊柱结核诊疗中的应用[J]. 中国防痨杂志, 2021, 43(5): 468-474.
[7]	曹晓曼, 刘伟, 刘涛, 王春, 高广阔, 翟文廷, 陈玢, 吴春雨. 氟比洛芬酯对脊柱结核术后发热的影响分析[J]. 中国防痨杂志, 2021, 43(4): 409-412.
[8]	阮洪云, 李琦, 陈效友, 段鸿飞, 郭超, 操敏, 梁清涛, 王志茹, 杨扬, 孙桂新, 李华, 邓玲, 绍玲玲, 邢维祥, 张芸, 杨新婷. 结核性胸膜炎患者化疗时是否加用糖皮质激素对肺功能动态变化的对比研究[J]. 中国防痨杂志, 2021, 43(1): 58-65.
[9]	张丽娟, 陶晓, 夏丽莉, 魏芬芬, 郑琦. 脊柱结核患者围手术期应用加速康复集束化护理临床路径表的价值[J]. 中国防痨杂志, 2020, 42(9): 981-986.
[10]	盛杰, 朱洋, 地里下提·阿不力孜, 唐伟, 古甫丁, 宋兴华. 表型与分子药物敏感性试验对术后耐药骨关节结核患者化疗的指导与效果分析[J]. 中国防痨杂志, 2020, 42(8): 838-844.
[11]	郑亚妹, 谢甜, 伍卓乐, 陈永倖. 经胸壁超声导入三联药品辅助治疗结核性胸膜炎的临床价值[J]. 中国防痨杂志, 2020, 42(7): 695-700.
[12]	鲍锐, 刘晓阳, 任鹏, 张峰, 梁海燕, 王茹, 付玲, 甘地守. 脊柱结核并发HIV感染患者手术治疗特点分析[J]. 中国防痨杂志, 2020, 42(6): 645-648.
[13]	何敏, 蒲育, 蔡玉郭, 李邦银, 何磊, 环明苍. 23例脊柱结核并发艾滋病患者的手术疗效观察[J]. 中国防痨杂志, 2020, 42(5): 454-458.
[14]	中国防痨协会骨结核专业分会. 新型冠状病毒肺炎疫情下骨关节结核外科的管理规范[J]. 中国防痨杂志, 2020, 42(3): 185-190.
[15]	邱磊,张少言,郭晓燕,付际游,田黎明,张惠勇,鹿振辉. 化疗方案加芩部丹片治疗复治涂阳肺结核患者的临床价值[J]. 中国防痨杂志, 2020, 42(2): 108-114.