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目的:探讨现代喉结核的临床特征及诊断要点。方法:回顾性分析近8年在我科喉镜室经病理确诊的33例喉结核患者的临床资料。结果:喉结核的主要症状为声嘶喉痛,多数不伴有肺结核(63.6%)。低热、盗汗、消瘦全身症状少见(24.2%)。喉镜检查总结为3种类型:水肿型,增生型和溃疡渗出型。结核菌素纯化蛋白(PPD)检查阳性率87.9%,痰菌检查阳性率68.4%。病理切片可见间质吞噬细胞及巨细胞反应,类上皮细胞和朗汉斯巨细胞增生构成肉芽肿,与坏死组织并存,干酪样坏死灶是其典型表现。结论:现代喉结核的临床特征是喉局部症状严重而全身症状轻,诊断上主要依靠详细的病史、喉镜所见和PPD痰菌检查联合使用,最后确诊尚需病理活检和结核杆菌培养。
Objective: To explore the clinical features and diagnosis of modern laryngeal tuberculosis. Methods: The clinical data of 33 cases of laryngeal tuberculosis confirmed by pathology in our department laryngoscope room in recent 8 years were analyzed retrospectively. Results: The main symptoms of laryngeal tuberculosis were sizzling sore throat, most of them were not associated with pulmonary tuberculosis (63.6%). Low fever, night sweats, weight loss systemic symptoms are rare (24.2%). Laryngoscopy is summarized in three types: edematous, hyperplastic and ulcer exudation. The positive rate of tuberculin purified protein (PPD) was 87.9% and the positive rate of sputum bacterium was 68.4%. Pathological sections of interstitial phagocytes and macrophages can be seen reaction, epithelial cells and Langers giant cell hyperplasia granuloma, and necrotic tissue coexist, caseous necrosis is its typical performance. Conclusion: The clinical features of modern laryngeal tuberculosis are local symptoms of throat and mild systemic symptoms. The diagnosis mainly depends on the detailed medical history. Combined with laryngoscopy and PPD sputum examination, pathological biopsy and Mycobacterium tuberculosis culture are still required.