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目的探讨溃疡性皮肤结核的临床特点、误诊原因及其防范措施。方法回顾性分析2005年6月—2014年6月新疆医科大学第二附属医院收治的曾误诊的溃疡性皮肤结核8例的临床资料。结果本组病变均发生在小腿,病初表现为局部皮肤红斑、丘疹、结节,继而发展为溃疡、糜烂、肿胀、疼痛,均无全身结核中毒症状。在外院首诊误诊为下肢静脉曲张静脉性溃疡4例,下肢皮肤癌2例,Bowen病2例。误诊时间5~36个月,平均20.5个月。入我院后根据病史、临床表现、结核菌素纯蛋白衍生物试验、结核感染T淋巴细胞斑点试验、溃疡灶分泌物结核杆菌抗酸染色及病理检查等确诊7例,未取得病理诊断依据经诊断性抗结核治疗确诊1例。8例确诊后均给予全身正规抗结核治疗11个月,局部病灶换药治疗6~9个月痊愈,均未植皮。随访12~18个月,无复发。结论溃疡性皮肤结核较为罕见且临床表现不典型,易误诊。临床遇及病程长、久治不愈的小腿溃疡灶者应考虑到溃疡性皮肤结核,要及时行病理检查,必要时给予诊断性抗结核治疗,以早期确诊。
Objective To investigate the clinical features, causes of misdiagnosis and preventive measures for ulcerative skin tuberculosis. Methods The clinical data of 8 cases of misdiagnosed ulcerated skin tuberculosis admitted to the Second Affiliated Hospital of Xinjiang Medical University from June 2005 to June 2014 were retrospectively analyzed. Results This group of lesions occurred in the lower leg, early stage of the disease showed partial skin erythema, papules, nodules, and then developed into ulcers, erosion, swelling, pain, no symptoms of systemic tuberculosis. In the first outpatient diagnosis of misdiagnosed as venous leg ulcers in 4 cases, 2 cases of skin cancer, Bowen’s disease in 2 cases. Misdiagnosis time of 5 to 36 months, an average of 20.5 months. Into our hospital according to medical history, clinical manifestations, tuberculin pure protein derivative test, tuberculosis infection T lymphocyte plaque test, ulcer foci Mycobacterium tuberculosis acid-fast staining and pathological examination were diagnosed in 7 cases, did not get pathological diagnosis based on Diagnostic anti-TB treatment was diagnosed in 1 case. 8 cases were diagnosed with systemic anti-TB therapy for 11 months, local lesions dressing change 6 to 9 months, no skin graft. Follow-up 12 to 18 months, no recurrence. Conclusion The ulcerative skin tuberculosis is relatively rare and the clinical manifestations are not typical, easily misdiagnosed. Clinical experience and long course, long-lasting healing of calf ulcers should consider ulcerative skin tuberculosis, to be timely pathological examination, if necessary, give diagnostic TB treatment to early diagnosis.