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总结26例耳鼻咽喉和颈淋巴结结核,结合文献分析其临床表现的变化和诊断要点,发现与过去相比,其病变程度和局部、全身症状明显减轻;与肺结核的关系不如以前密切;原发性和血行播散性病变的比例增大;局部以肉芽或增殖性病变为主,溃疡或坏死性病变较轻,外观更象恶性肿瘤。在诊断上,熟悉此病临床表现的变迁,提高警惕性,是防止误诊和漏诊的重要方面。病理学检查仍是主要确诊手段;有时需反复多次活检才能确诊。对病理学难以确诊的病例,应做改良抗酸染色(IntensifiedKinyoun,IK)或免疫组化染色,以检测常规病理学检查不易发现的L型菌;治疗试验有重要的辅助诊断价值。临床表现发生变迁的原因与结核菌L型可能有关。
Summary of 26 cases of otolaryngology and cervical lymph node tuberculosis, combined with the literature analysis of the clinical manifestations of the changes and diagnostic points and found that compared with the past, the lesion severity and local, systemic symptoms significantly reduced; and tuberculosis is not as close as before; primary And hematogenous disseminated lesions increased proportion of local granulation or proliferative lesions, ulceration or necrotic lesions lighter, the appearance of more like malignant tumors. In the diagnosis, familiar with the clinical manifestations of the disease changes and improve their vigilance is to prevent misdiagnosis and missed an important aspect. Pathological examination is still the main means of diagnosis; sometimes multiple biopsies to be confirmed. Pathological difficult to confirm the diagnosis of cases, should be done to improve acid-fast staining (IntensifiedKinyoun, IK) or immunohistochemical staining, to detect routine pathological examination is not easy to find L-type bacteria; treatment test has important diagnostic value. Clinical manifestations of the reasons for the change may be related to the L-form of Mycobacterium tuberculosis.