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目的分析18例喉结核患者的临床特征及诊断要点。方法回顾性分析天津市第一中心医院收治的18例喉结核患者的临床资料。结果主要症状包括声音嘶哑、咽痛、咽异物感、吞咽困难、咯血及咳嗽等,全身症状不明显。喉部特征性表现:喉部苍白水肿、增生结节、溃疡糜烂。经胸CT或胸部X线平片证实,10例患有肺结核,但未经规范抗痨治疗。9例行痰涂片抗酸染色,阳性1例。14例行病理诊断,发现阳性杆菌6例,阳性率42.9%。所有患者确诊后转结核病防治所行抗痨治疗,发现喉结核合并喉癌1例。结论喉结核的发生与肺结核密切相关,天津地区肺结核经呼吸道的直接传播仍是喉结核的主要感染途径;患者全身症状不明显,易造成误诊、漏诊;纤维喉镜下或全麻手术下病理活检是喉结核确诊的主要手段。
Objective To analyze the clinical features and diagnosis points of 18 cases of laryngeal tuberculosis. Methods The clinical data of 18 patients with laryngeal tuberculosis admitted to the First Central Hospital in Tianjin were retrospectively analyzed. Results The main symptoms include hoarseness, sore throat, swallowing foreign body sensation, swallowing difficulties, hemoptysis and coughing, with no obvious systemic symptoms. Throat characteristic manifestations: laryngeal pale edema, hyperplastic nodules, ulcer erosion. Trans-thoracic CT or chest X-ray confirmed that 10 patients had tuberculosis, but without standard anti-tuberculosis treatment. 9 cases of sputum smear acid-fast staining, positive in 1 case. 14 cases of pathological diagnosis, positive bacteria found in 6 cases, the positive rate of 42.9%. All patients were diagnosed after TB treatment of anti-tuberculosis treatment and found laryngeal tuberculosis with laryngeal cancer in 1 case. Conclusions The occurrence of laryngeal tuberculosis is closely related to pulmonary tuberculosis. The direct transmission of pulmonary tuberculosis through the respiratory tract in Tianjin is still the main route of infection of laryngeal tuberculosis. The general symptoms of patients are not obvious, which may lead to misdiagnosis and missed diagnosis. Pathological biopsy under fibrolaryngology or general anesthesia Is the main method of diagnosis of laryngeal tuberculosis.