Kuypers F Y, Zwierstra R P, de Langen Z J
Academisch Ziekenhuis, afd. Kinderchirurgie, Groningen.
Ned Tijdschr Geneeskd. 1995 Oct 7;139(40):2036-9.
A retrospective study was made of 43 consecutive cases of children with the diagnosis of non-tuberculous mycobacterial lymphadenitis treated in our surgical department between 1976 and 1992. In 16 of the 42 children the diagnosis was initially missed and these children elsewhere underwent incision and drainage resulting in a chronic sinus. In 37 children the disease was localized in the head-and-neck area, while in the other 6 inguinal or axillary lymph nodes were involved. All 43 children underwent a regional lymph node dissection with a partial parotidectomy in three. In 5 children recurrent disease developed within 4 months after dissection. The recurrences were all successfully treated with additional surgery. In none of the children did the dissection result in permanent damage of nerves, especially not of the facial nerve. The cosmetic results were good but depended on the possibilities of entering the neck through a cosmetically ideal incision. Early recognition of the disease is of the utmost importance for an adequate surgical and cosmetically desirable result. An aggressive surgical therapy is advocated and will not result in permanent damage provided the surgeon has the technical skill required for neck dissections.
对1976年至1992年间在我们外科治疗的43例连续诊断为非结核分枝杆菌性淋巴结炎的儿童病例进行了回顾性研究。42例儿童中有16例最初漏诊,这些儿童在其他地方接受了切开引流,导致慢性窦道。37例儿童疾病局限于头颈部区域,另外6例腹股沟或腋窝淋巴结受累。所有43例儿童均接受了区域淋巴结清扫术,其中3例行部分腮腺切除术。5例儿童在清扫术后4个月内出现疾病复发。所有复发均通过再次手术成功治疗。没有儿童因清扫术导致神经永久性损伤,尤其是面神经。美容效果良好,但取决于通过美容理想切口进入颈部的可能性。早期识别该疾病对于获得充分的手术效果和理想的美容效果至关重要。提倡积极的手术治疗,只要外科医生具备颈部清扫所需的技术技能,就不会导致永久性损伤。