Wright J E
Department of Paediatric Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
Aust N Z J Surg. 1996 Apr;66(4):225-8. doi: 10.1111/j.1445-2197.1996.tb01170.x.
Non-tuberculous mycobacterial lymphadenitis has been recognized since medieval times by an array of names. The condition is familiar to paediatricians and paediatric surgeons but it often is not recognized in its early stages. A paediatric surgeon's experience of the condition in Newcastle over 30 years is reviewed.
A personal series of children with non-tuberculous mycobacterial lymphadenitis treated in Newcastle from 1966 to 1994 is reviewed. Clinical diagnosis was supported by multiple Mantoux skin testing in most patients using human purified protein derivative (PPD) and avian antigens. All were treated surgically with histological confirmation of the diagnosis. A total of 89 patients were encountered. Twenty-two were seen in hospital practice between 1966 and 1976 and have already been reported. The current paper presents the results of analysis of the clinical features, diagnosis and surgical treatment of the remaining 67 patients seen in paediatric surgical practice between 1976 and 1994.
There was equal sex distribution. Ages ranged from 1 to 10 years, with none under 1 year, and 82% of the patients were in the pre-school age group. Cervical lymph nodes were involved in all, the majority being jugulo-digastric or submandibular. Surgical excision by limited dissection of lymph nodes was performed in 55 patients with one recurrence, and by excision and curettage in eight patients with two recurrences. Simple bacterial wound infection occurred in four patients and two had prolonged postoperative suppuration as a result of mycobacterial wound infection. Paresis of the mandibular or cervical branch of the facial nerve occurred in 50% of patients where the nerve was at risk, but the majority of these recovered although it took over 6 months in some children. Culture for mycobacterial organisms was positive in only 29 patients.
The diagnosis of non-tuberculous mycobacterial lymphadenitis is clinical and its early recognition requires an awareness of the condition. It can be confirmed by multiple Mantoux testing or fine needle aspiration biopsy. The treatment is local excision of the affected lymph nodes. Histological examination and mycobacterial culture should be performed.
非结核分枝杆菌性淋巴结炎自中世纪以来就有一系列名称。儿科医生和小儿外科医生对这种疾病较为熟悉，但在其早期阶段往往难以识别。本文回顾了一位小儿外科医生在纽卡斯尔30多年来对该病的诊治经验。
回顾了1966年至1994年在纽卡斯尔接受治疗的一系列非结核分枝杆菌性淋巴结炎患儿病例。大多数患者通过使用人纯化蛋白衍生物（PPD）和禽抗原进行多次结核菌素皮肤试验来辅助临床诊断。所有患者均接受手术治疗，并经组织学确诊。共诊治89例患者。其中1966年至1976年在医院诊治的22例已报道。本文介绍了1976年至1994年在小儿外科诊治的其余67例患者的临床特征、诊断及手术治疗分析结果。
男女比例均等。年龄范围为1至10岁，无1岁以下患者，82%的患者处于学龄前年龄段。所有患者均累及颈部淋巴结，多数为颈二腹肌淋巴结或下颌下淋巴结。55例患者行有限淋巴结清扫术切除，1例复发；8例患者行切除及刮除术，2例复发。4例患者发生单纯细菌性伤口感染，2例因分枝杆菌伤口感染导致术后长期化脓。在面神经下颌支或颈支有损伤风险的患者中，50%出现面神经麻痹，但大多数患者恢复，尽管部分儿童恢复时间超过6个月。仅29例患者的分枝杆菌培养呈阳性。
非结核分枝杆菌性淋巴结炎的诊断主要依靠临床，早期识别需要对该病有所认识。可通过多次结核菌素试验或细针穿刺活检确诊。治疗方法为局部切除受累淋巴结。应进行组织学检查和分枝杆菌培养。
