Srivanitchapoom Chonticha, Yata Kedsaraporn
Otolaryngology Unit, Phayao Hospital, 269 moo 11, Tumbon Bantom, Muang Phayao, Phayao 56000, Thailand.
Otolaryngology Unit, Phayao Hospital, 269 moo 11, Tumbon Bantom, Muang Phayao, Phayao 56000, Thailand.
Auris Nasus Larynx. 2020 Oct;47(5):887-894. doi: 10.1016/j.anl.2020.04.007. Epub 2020 May 1.
Lymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage.
We retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed.
There were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation.
Following SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas.
经验性抗生素治疗可成功治疗淋巴结炎。然而，发炎的淋巴结可能发展为伴有局部和/或全身反应的脓肿，这需要更复杂的治疗策略。本研究旨在分析需要手术引流的发炎淋巴结内脓肿形成的可能预测因素。
我们回顾性纳入了241例急性或亚急性颈淋巴结炎患者。记录人口统计学资料、淋巴结特征、治疗方法及最终诊断结果。采用单因素和多因素分析评估需要手术引流的淋巴结内脓肿形成的预测因素。还分析了区分化脓性颈淋巴结炎（SCL）与其他淋巴结炎的患者及淋巴结特征。
有41例SCL，173例非复杂性颈淋巴结炎，27例结核性颈淋巴结炎（TBLN）。39例患者接受了脓肿手术引流，2例患者接受了针吸术。9例SCL患者的并发症包括颈部软组织蜂窝织炎、声门上肿胀、颈内静脉血栓形成和脓毒症。2例患者在引流后被诊断为类鼻疽和放线菌病。多因素分析显示，免疫功能低下宿主、男性以及先前接受不充分治疗是手术引流的预测因素。TBLN患者与SCL患者表现相似。然而，SCL患者受影响的淋巴结单一、疼痛且有波动感。
确诊SCL后，应考虑脓肿引流及适当的抗生素治疗。针吸或手术引流对某些患者可能有效。应进行病原体分离和组织活检以确保准确诊断和抗生素选择。此外，应考虑TBLN和类鼻疽，尤其是在流行地区。
