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目的:分析卡介苗接种致结核性淋巴结炎临床特点,提高儿科医生识别此病临床诊断能力。方法:根据临床诊断标准、结核菌素试验(PPD)、影像学检查法、外周淋巴结病理活检或细胞学检查进行综合分析。结果:卡介苗接种侧腋下淋巴结肿大者15例(占29%)。卡疤同侧腋下淋巴结肿大并锁骨上淋巴结肿大者19例(占37%)。双侧腋下淋巴结肿大并卡疤侧锁骨上淋巴结肿大者17例(占33%)。PPD试验43例呈+++阳性反应,8例呈++++阳性反应。17例淋巴结病理活检,8例显示结核肉芽肿病变,9例显示干酪样坏死病变。34例淋巴结穿刺,细胞学检查显示有郎罕斯细胞浸润。结论:卡介苗接种时应充分溶解摇匀菌液,避免过量过深注射,一旦发生结核性淋巴结炎,>2cm以上需抗痨治疗,>4cm以上应寻求外科切除治疗。
Objective: To analyze the clinical features of BCG vaccination induced tuberculous lymphadenitis and improve the ability of pediatricians to recognize the clinical diagnosis. Methods: According to clinical diagnostic criteria, tuberculin test (PPD), imaging examination, peripheral lymph node biopsy or cytology comprehensive analysis. Results: There were 15 cases (29%) of BCG vaccination with axillary lymph nodes. Cardiac ipsilateral axillary lymph nodes and supraclavicular lymph nodes in 19 cases (37%). Bilateral armpit lymph nodes and scar side of the supraclavicular lymph nodes in 17 cases (33%). In the PPD test, 43 cases showed +++ positive reaction and 8 cases showed ++++ positive reaction. Seventeen patients were pathologically biopsied for lymph nodes, eight had tuberculous granuloma lesions, and nine had lesions of caseous necrosis. 34 cases of lymph node puncture, cytology showed Lang Lan Si cell infiltration. Conclusion: BCG vaccination should be fully dissolved shake shake bacteria to avoid excessive injection too deep, in the event of tuberculous lymphadenitis,> 2cm above need anti-tuberculosis treatment,> 4cm or more surgical resection should seek treatment.