两种不同手术方式对颈部淋巴结结核患者的疗效分析

doi:10.3969/j.issn.2096-8493.2021.01.007

摘要/Abstract

摘要：

目的探讨颈部淋巴结结核病灶清除术与病灶清除术联合区域淋巴结清扫术,两种不同手术方式对颈部淋巴结结核患者的疗效。方法回顾性分析黑龙江省传染病防治院综合外科2016年1月至2019年1月收治的347例经细菌学或病理学诊断为颈部淋巴结结核并进行外科手术治疗的患者,其中112例实施了常规的病灶清除术,作为对照组; 235例实施了病灶清除术联合区域淋巴结清扫术,作为研究组。分析两组患者进行手术治疗的治愈率、生命质量量表(QOL)评分改善情况、切口愈合情况,以及并发症的发生情况。结果研究组治愈率(97.9%,230/235)明显高于对照组(84.8%,95/112),差异有统计学意义(χ²=6.14,P=0.029)。研究组术后切口甲级愈合率(90.6%,213/235)明显高于对照组(63.4%,71/112),差异有统计学意义(χ²=4.71,P=0.018);研究组乙级愈合率(8.5%,20/235)和丙级愈合率(0.9%,2/235)分别明显低于对照组乙级愈合率(25.0%,28/112)和丙级愈合率(11.6%,13/112),差异均有统计学意义(χ²值分别为5.16和4.43,P值分别为0.032和0.028)。研究组并发症发生率(5.1%,12/235)明显低于对照组(17.9%,20/112),差异有统计学意义(χ²=4.17,P=0.012)。术后抗结核治疗3个月,研究组QOL评分[(52.83±2.19)分]明显高于对照组[(39.12±2.08)分],差异有统计学意义(t=8.92,P=0.001)。结论病灶清除联合区域淋巴结清扫术可有效提高患者术后治愈率,提高患者术后切口甲级愈合程度,降低术后并发症发生率,提升患者生存质量。

关键词: 结核, 淋巴结, 颈淋巴结清扫术, 淋巴结切除术, 疗效比较研究

Abstract:

Objective To explore and analyze the effectiveness of two different surgical methods on treating cervical lymph node tuberculosis. Methods A total of 347 patients with cervical lymph node tuberculosis diagnosed bacteriologically or pathologically and treated by surgery in the Department of General Surgery of Heilongjiang Infectious Disease Hospital from January 2016 to January 2019 were retrospectively analyzed. Among them, 112 patients were treated with conventional debridement as the control group; 235 patients were treated with debridement combined with regional lymph node dissection as the study group. Cure rates, improvements of quality of life (QOL) scale, wound healing and complications of the two groups were analyzed. Results Cure rate of the study group (97.9%, 230/235) was significantly higher than that of the control group (84.8%, 95/112), the difference was statistically significant (χ²=6.14, P=0.029). Wound healing rate of grade A in the study group (90.6%, 213/235) was higher than that of the control group (63.4%, 71/112), the difference was statistically significant (χ²=4.71, P=0.018); the healing rates of grade B (8.5%, 20/235) and grade C (0.9%, 2/235) in the study group were lower than those of grade B (25.0%, 28/112) and grade C (11.6%, 13/112) in the control group, and those differences were statistically significant (χ²=5.16 and 4.43, P=0.032 and 0.028). Incidence of complications in the study group (5.1%, 12/235) was lower than that in the control group (17.9%, 20/112), the difference was statistically significant (χ²=4.17, P=0.012). After 3 months of anti-tuberculosis treatment, QOL score of the study group (52.83±2.19) was significantly higher than that of the control group (39.12±2.08), the difference was statistically significant (t=8.92, P=0.001). Conclusion Focus clearing combined with regional lymphadenectomy can effectively improve the postoperative healing rate, improve the rate of postoperative incision grade A healing, reduce the incidence of postoperative complications, and improve the quality of life of patients.

Key words: Tuberculosis, lymph node, Neck dissection, Lymph node excision, Comparative effectiveness research

张哲男, 姜南阳, 王威, 姜连炬, 刘玉琴. 两种不同手术方式对颈部淋巴结结核患者的疗效分析[J]. 结核与肺部疾病杂志, 2021, 2(1): 26-30. doi: 10.3969/j.issn.2096-8493.2021.01.007

ZHANG Zhe-nan, JIANG Nan-yang, WANG Wei, JIANG Lian-ju, LIU Yu-qin. Analysis of the effectiveness of two different surgical methods on treating cervical lymph node tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(1): 26-30. doi: 10.3969/j.issn.2096-8493.2021.01.007

图/表 2

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