Pediatric Infectious Diseases-General Pediatrics, St Luc University Hospital, Brussels, Belgium.
Institute of Experimental and Clinical Research (IREC), Catholic University of Louvain, Brussels, Belgium.
Eur Arch Otorhinolaryngol. 2020 Jun;277(6):1785-1792. doi: 10.1007/s00405-020-05880-5. Epub 2020 Mar 6.
Granulomatous inflammation is a common cause of subacute cervicofacial lymphadenitis in children. Nontuberculous mycobacterial (NTM) infections and cat-scratch disease (CSD) are the most frequent causes. Optimal treatment, which may include surgery, antibiotic treatment or wait-and-see approach, is debatable. The goal of this study was to compare the short- and long-term outcome of various surgical procedures.
Case series with a chart review of all children treated by surgical excision of granulomatous lymph nodes in the cervicofacial area from 2000 to 2016 at two tertiary care centers.
Forty patients were included in this study. The median age at first symptoms was 3.7 years (13 months-14 years). Mean follow-up was 5.8 years (6 months-15.3 years). 25 patients fit with diagnosis of NTM infection, 6 with CSD while diagnosis remained uncertain in 9 patients. The primary surgical procedure consisted of total excision (n = 27), incision/drainage (n = 9) or incomplete excision (n = 4). None of the patients treated by primary complete excision needed further intervention contrary to the group of patients with incomplete surgical procedures where additional surgical management was required in 54%. At follow-up, all patients were healthy without evidence of recurrence.
We advocate early surgical intervention with complete excision to reach quick resolution and reduce the need for additional surgery. The long-term outcome was favorable.
肉芽肿性炎症是儿童亚急性颈面部淋巴结炎的常见病因。非结核分枝杆菌（NTM）感染和猫抓病（CSD）是最常见的病因。最佳治疗方案（包括手术、抗生素治疗或观察等待）存在争议。本研究旨在比较各种手术的短期和长期疗效。
这是一项回顾性病例系列研究，对 2000 年至 2016 年在两家三级护理中心接受手术切除颈面部肉芽肿性淋巴结的所有儿童的病历进行了回顾。
本研究共纳入 40 例患者。首发症状的中位年龄为 3.7 岁（13 个月-14 岁）。平均随访时间为 5.8 年（6 个月-15.3 年）。25 例患者诊断为 NTM 感染，6 例诊断为 CSD，9 例患者的诊断仍不确定。初次手术方式包括完全切除（n=27）、切开引流（n=9）或不完全切除（n=4）。与不完全手术组（54%需要进一步手术干预）相比，行初次完全切除的患者无一例需要进一步干预。随访时，所有患者均健康，无复发迹象。
我们主张早期行完全切除的手术干预，以迅速缓解病情并减少再次手术的需要。长期疗效良好。
