摘要
目的探讨以颈部淋巴结肿大为首发症状的儿童淋巴瘤临床特征,分析外科手术在儿童淋巴瘤诊疗中的作用。方法回顾性分析华中科技大学同济医学院附属武汉儿童医院普外科2013年1月至2021年1月收治的22例以颈部淋巴结肿大为首发症状的淋巴瘤患儿临床资料,总结患儿临床特点、诊治过程以及预后情况。结果本研究纳入的22例淋巴瘤患儿中,男14例、女8例,病程2周至6年4个月;肿大淋巴结直径2~10 cm,中位直径5 cm。14例表现为无痛性淋巴结增大,9例先发热后出现颈部淋巴结增大,8例伴有局部红肿、触痛。13例接受了抗感染治疗,其中3例淋巴结缩小,10例未见缓解。22例均通过淋巴结活检明确诊断,其中非霍奇金淋巴瘤16例,依据St.Jude NHL分期系统,Ⅱ期3例、Ⅲ期7例、Ⅳ期6例;霍奇金淋巴瘤6例,依据Ann Arbor分期系统,Ⅱ期4例、Ⅳ期2例。结论儿童颈部淋巴瘤临床症状不典型,易出现漏诊和误诊;对于颈部淋巴结增大超过2 cm,伴或不伴局部红肿、触痛,经保守治疗1周淋巴结未缩小或缩小不明显者,需考虑行淋巴结活检。
Objective To explore the clinical characteristics of childhood lymphoma(CL)with cervical lymphadenopathy as an initial symptom and examine the role of surgery in its management.Methods From January 2013 to January 2021,the relevant clinical data were retrospectively reviewed for 22 CL children with cervical lymphadenopathy as an initial symptom.Clinical features,diagnoses,treatments and outcomes were summarized.Results There were 14 boys and 8 girls with a disease course of 2 weeks to 76 months.The enlarged lymph nodes had a median diameter of 5(2-10)cm.There were painless lymph node enlargement(n=14),fever followed by cervical lymphadenopathy(n=9)and concurrent local redness,swelling and tenderness(n=8).Among 13 recipients of antibiotics,lymph nodes diminished(n=3)and showed no change(n=10).The diagnoses of non-Hodgkin's lymphoma(NHL,n=16)and Hodgkin's lymphoma(HL,n=6)were confirmed by biopsy.The stages of NHL wereⅡ(n=3),Ⅲ(n=7)andⅣ(n=6)according to St Jude NHL staging system.And the stages of HL wereⅡ(n=4)andⅣ(n=2)based upon Ann Arbor staging system.Conclusions Clinical symptoms of cervical lymphoma are generally atypical in children.It is prone to a missed or under diagnosis.Lymph node biopsy is indicated for cervical lymphadenopathy enlarging by more than 2 cm with or without local redness,tenderness and lymph nodes failing to shrink obviously after 1-week conservative treatment.
作者
彭飞
闫学强
梁翀
袁强
段栩飞
Peng Fei;Yan Xueqiang;Liang Chong;Yuan Qiang;Duan Xuefei(Department of General Surgery,Affiliated Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)
出处
《临床小儿外科杂志》
CAS
CSCD
北大核心
2024年第1期66-71,共6页
Journal of Clinical Pediatric Surgery
基金
湖北省自然科学基金一般面上项目(2022CFB470)
