摘要
背景：結核菌除肺部感染等外，也可經由血液或淋巴系統散佈至身體其他部位，進而導致肺外結核。肺外結核以頭頸淋巴結核最常見，其次為胸膜結核、骨或關節結核、泌尿生殖系統結核、腦膜、腹膜和未分類之肺外結核。方法：本研究以回溯性病例收集2008年1月1日至2013年8月31日共6年間，於童綜合醫療社團法人童綜合醫院確診之結核病病例。統計分析肺及肺外結核病例，特別針封頭頸部結核的病例，進行分析與歸納。結果：結核病確診病例共517例，肺結核484例，其中肺結核合併肺外結核16例；肺外結核33例。頭頸部結核13例中，10例為結核性淋巴腺炎，1例為原發性鼻咽結核，1例為次發性鼻咽結核，1例為肺結核合併喉部結核。單一頸部腫塊外科處理方式為切除性切片，多發性頸部腫塊、鼻咽及喉部腫塊則採部分切除或切片檢查。頭頸部結核患者病理組織報告均為結核性肉芽腫。7例完成TB藥物治療，4例轉院，2例失聯。結論：頭頸部結核在肺外結核感司生中非少見，但其臨床表現並不具特異性，因此早期診斷及和其他疾病鑑剎診斷，以防止併發症及延誤治療，是臨床醫師重要的課題。
並列摘要
Background: Tuberculosis (TB) infection is primarily in the lungs, but TB bacilli may spread through the hematogenous or lymphatic system to other parts of the body resulting in extrapulmonary tuberculosis. Common extrapulmonary sites include the lymph nodes, pleura, gastrointestinal tract, bone tissue, central nervous system, and urogenital system. For head and neck tuberculosis infection, the most common site is the cervical lymph nodes. Methods: All the tuberculosis cases diagnosed in Tungs' Taichung MetroHarbor Hospital from January 1, 2008 to August 31, 2013 including inpatients, outpatients, and patients of emergency department were collected retrospectively. The distribution, gender, and age were recorded. We analyzed clinical manifestations, diagnosis and treatment of the head and neck tuberculosis cases. Results: Of the total 517 cases of TB included in this study, there were 484 cases of pulmonary TB, 16 cases of pulmonary TB with concomitant extrapulmonary TB and 33 cases of extrapulmonary TB. There were 13 cases of head and neck TB, which comprised of 10 cases of tuberculous lymphadenitis, a case of primary nasopharyngeal TB, a case of secondary nasopharyngeal TB, and a case of combined pulmonary and laryngeal TB. For single neck mass, we performed total removal of neck mass with excisional biopsy. For multiple neck masses, nasopharyngeal and laryngeal lesions, partial removal for biopsy was done. For all of head and neck TB pathologic results confirmed tuberculous granuloma. Seven patients completed TB medical treatment, 4 were transferred to other centers, and two were lost contact. Conclusions: Head and neck tuberculosis is no trare among extrapulmonary TB infections. As its clinical presentations are often nonspecific, early diagnosis and differential diagnosis are important to prevent complications and delay in treatment.
延伸閱讀
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