鼻咽结核15例临床分析.DOCVIP

临床医学论文-鼻咽结核15例临床分析 ????????????????????????? ?作者：蔡永明 张文渊 周佳慧?? 【关键词】? 鼻咽结核 ??? 摘要：目的：为提高鼻咽结核的临床诊断率。方法：对15例鼻咽结核进行回顾性分析，总结其临床特征，仅3例有肺结核史（20.0%），8例以颈部包块为首发临床表现（53.3%），11例初发时误诊为鼻咽部恶性肿瘤（73.3%）。结果：全部病例经正规抗结核药物治疗后痊愈，经6个月至2年随诊无复发。结论：鼻咽结核与鼻咽癌极易误诊，颈淋巴结肿大时要注意排除鼻咽结核并于鼻咽部恶性肿瘤相鉴别；鼻咽结核行全身抗痨治疗，同时应用5%链霉素局部灌洗，可显著提高疗效，缩短病程。 ??? 关键词：结核；鼻咽疾病；颈淋巴结肿大 ??? Nasopharyngeal Tuberculosis: An Analytical Study and Report on 15 Cases ??????? Abstract: Objective:To improve diagnostic rate of nasopharyngeal tuberculosis.Method:15 cases of nasopharyngeal tuberculosis were retrospectively analyzed and the clinical features were studied . Only three cases had known the previous history of pulmonary tuberculosis (20.0%). Cervically lymphadenopathy was the most common presenting symptom in our series (8 cases 53.3%) . 11 cases were diagnosed as nasopharyngeal malignant tumors by mistake at the beginning (73.3%) . Result: Anti-tuberculous medical treatment was successfuful in all patients after follow up from 6 months to 2 years. Conclusion: It was made a mistake in diagnosis easily between the nasopharyngeal tuberculosis and the nasopharyngeal malignant tuberculous . When cervical lymphadenopathy is found , nasopharyngeal malignant tuberculous is the most important disease in differential diagnosis for their similar clinical features . Systematic antituberculosis therapy combined with nasopharyngeal irrigation (5% streptomycin) can improve the efficacy of treatment. 牋?Key words:Tuberculosis;Nasopharyngeal diseases;Deradenoncus ??? 为提高鼻咽结核的临床诊断率，现对1994年7月至2003年12月作者诊治的15例鼻咽结核的临床资料进行回顾性分析，报道如下： ??? 1资料与方法 ??? 1.1临床资料：本组鼻咽结核15例，男8例、女7例。年龄16～42岁，≤30岁为11例，占73.3%。临床表现颈淋巴结肿大12例，其中4例为双侧颈淋巴结肿大。淋巴结肿大个数：多个10例，单个（融合而成）2例。淋巴结部位：胸锁乳突肌后缘中部8例，胸锁乳突肌后缘下部2例，颌下1例。淋巴结肿大大小：1cm×1cm×1.5cm～2cm×5cm×3cm ，大小不等。肿大淋巴结性质：质硬不活动8例，质中活动3例，压痛1例，其中8例以颈部包快为首发临床表现，伴咽干痛不适，异物感5例，涕血5例，耳鸣4例，听力下降1例，头痛1例。15例均有胸部X线拍片，发现2例浸润型肺结核，1例纤维性结核。鼻咽结核病变部位，12例在鼻咽顶部，2例在侧壁，鼻咽顶与侧壁同时受累1例。局部粘膜病变呈结节状7例，苍白或充血水肿4例，溃疡4例。所有病例病变表面都不同程度的覆盖有分泌物。耳部检查：中耳积液1例。鼻咽CT检查未见颅底骨质破