Chongkolwatana C, Nilsuwan A, Chongvisal S, Keskool P, Metheetrairut C
Department of Otolaryngology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1998 May;81(5):329-33.
Nasopharyngeal tuberculosis used to be a common disease in the upper aerodigestive system. Before 1920, 1.4 and 6.5 per cent of all adenoids and tonsils removed from asymptomatic patients were infected by tuberculosis. After the introduction of antituberculous chemotherapy and BCG vaccination, this disease was considered uncommon and sporadic cases were reported in the medical literature. Recently, tuberculosis has begun to increase again due to the high global HIV-infected rate and antituberculous drug resistance among these people. To describe and highlight the clinical features of this condition, fifteen Thai patients (7 males and 8 females) from the Department of Otolaryngology, Siriraj Hospital, Bangkok, Thailand were reviewed. Cervical lymphadenopathy was the most common presenting symptom in our series (93.34%), 11 of them were classified as primary nasopharyngeal tuberculosis and most had abnormal nasopharyngeal findings by mirror examination except 2 cases. Although all had histopathological confirmation of nasopharyngeal tuberculosis, sometimes problems occur in the diagnosis between this disease and nasopharyngeal carcinoma, which are also common among Oriental people in many of their clinical similarities. Therefore routine nasopharyngeal biopsy is considered justified and diagnostic.
鼻咽结核曾是上呼吸道消化系统的常见疾病。1920年以前，从无症状患者中切除的腺样体和扁桃体分别有1.4%和6.5%受到结核感染。在抗结核化疗和卡介苗接种引入后，这种疾病被认为不常见，医学文献中仅报道过散发病例。近年来，由于全球艾滋病病毒感染率高以及这些人群中出现耐抗结核药物情况，结核病发病率又开始上升。为了描述和突出这种疾病的临床特征，我们回顾了泰国曼谷诗里拉吉医院耳鼻喉科的15例泰国患者（7例男性和8例女性）。颈部淋巴结肿大是我们系列病例中最常见的症状（93.34%），其中11例被归类为原发性鼻咽结核，除2例患者外，大多数患者通过间接鼻咽镜检查发现鼻咽部异常。尽管所有患者均经组织病理学确诊为鼻咽结核，但有时在诊断这种疾病与鼻咽癌之间会出现问题，这两种疾病在许多临床特征上有相似之处，在东方人群中都较为常见。因此，常规鼻咽活检被认为是合理且具有诊断价值的。
