一家三级儿童医院非结核分枝杆菌淋巴结炎的管理：20年经验
Management of nontuberculous mycobacterial lymphadenitis in a tertiary care children's hospital: A 20year experience.
作者信息
Naselli Aldo, Losurdo Giuseppe, Avanzini Stefano, Tarantino Vincenzo, Cristina Emilio, Bondi Elisabetta, Castagnola Elio
机构信息
Infectious Diseases Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy.
Pediatric Surgery Unit, Istituto Giannina Gaslini, Ospedale Pediatrico IRCCS, Genova, Italy.
出版信息
J Pediatr Surg. 2017 Apr;52(4):593-597. doi: 10.1016/j.jpedsurg.2016.08.005. Epub 2016 Aug 25.
PURPOSE
Nontuberculous mycobacteria are uncommon cause of chronic cervicofacial lymphadenitis in healthy children. We describe clinical features and management strategies of cervicofacial nontuberculous mycobacterium lymphadenitis in a tertiary pediatric hospital.
METHODS
Retrospective analysis of medical records of children discharged from 1992 to 2014 with a diagnosis of cervicofacial nontuberculous mycobacterium was made. Diagnosis certainty was based on microhistological investigations. Clinical stage was evaluated according to lymph node size and presence of fistulas. Successful therapy was defined by the regression of the lymph node enlargement (>75%) or complete surgical excision without relapse.
RESULTS
Cervicofacial nontuberculous mycobacterium was diagnosed in 33 patients. Complete excision was performed in 73% of cases primarily observed in our hospital, while 83% of those referred from other hospitals required further surgical treatment. No case of relapse was observed after one year of follow-up.
CONCLUSIONS
We recommend surgical approach as the first therapeutic option in the management of cervicofacial nontuberculous mycobacterium lymphadenitis.
LEVELS OF EVIDENCE
Prognosis and Retrospective Study - Level II.
目的
非结核分枝杆菌是健康儿童慢性颈面部淋巴结炎的罕见病因。我们描述了一家三级儿科医院中颈面部非结核分枝杆菌淋巴结炎的临床特征及治疗策略。
方法
对1992年至2014年诊断为颈面部非结核分枝杆菌的出院儿童病历进行回顾性分析。诊断的确立基于微观组织学检查。根据淋巴结大小及瘘管的存在情况评估临床分期。成功的治疗定义为淋巴结肿大消退（>75%）或手术完全切除且无复发。
结果
33例患者被诊断为颈面部非结核分枝杆菌感染。在我院初诊的病例中，73%进行了完整切除，而从其他医院转诊来的患者中，83%需要进一步手术治疗。随访一年未观察到复发病例。
结论
我们建议手术治疗作为颈面部非结核分枝杆菌淋巴结炎治疗的首选方案。
证据水平
预后及回顾性研究 - 二级。
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