卡介苗性淋巴結(jié)核課件

小兒卡介苗性淋巴結(jié)核的外科治療SurgicaltreatmentoftuberculouslymphadenitiscausedbyBCGvaccinationininfants

小兒外科柳宏金興碩連樹華卡介苗性淋巴結(jié)核IntroductionofBCGBCGistheacronymforBacillusCalmetteGuérin,BacillusisthemeaningofBacteria,CalmetteandGuérinarebothFrenchscientist,after13yearsofsubculture,theygotanattenuatedstrainBCG,canbeusedtopreventTBinfection,inchinesenamedaskajiemiao.BCGvaccinationknownasthefirstinjectionofnewborn,inthelateralupperarmdeltoid0.1mlintradermalinjection.BCGvaccinationofchildrenisverygoodforthehealthygrowth.卡介苗性淋巴結(jié)核TheuseofBCGTheoriginalforthepreventionoftuberculosisasaspecificimmuneagent.Italsohasfunctiontopromotemacrophagephagocytosisasanon-specificimmuneenhancer.Itisusedintreatmentofmalignantmelanoma,orlungcancer,acuteleukemia,malignantlymphomaafterradicalsurgeryorchemotherapyasadjuvanttreatment.ItwerealsoreceivedsomeeffectsofBCGtherapywithpediatricasthma,bronchitis,pediatricflupreventionandthepreventionandtreatmentofadultchronicbronchitis.卡介苗性淋巴結(jié)核ResponseaftervaccinationAfterBCGvaccinationofabout1to2weeks,thelocalsectionwillshowtheredknot,thengraduallygrewup,aslightitching,butnotfever;6to8weekstoformpusbubblesorulceration;10to12weeksbegantoscab,Afterthescaboffleavingasmallreddishscars,aftertheredcolorgraduallybecamenormal.Swollenlymphglandswouldemergeasabnormalreactions,mainlyrelatedtopersonalphysicalfitness,themorevulnerableyoungervaccination,alsowiththetypeofvaccinationorinoculationtoodeep,suchasvaccinationintheskin.卡介苗性淋巴結(jié)核AlthoughBCGhasplayedanimportantroleinpreventingTBinchildren,withtheuniversalvaccinationofBCG,asmallnumberofchildrenshowedenlargementofaxillarylymphnodesinvaccinatedside,evenbecometheTBmass,deservesourattention.卡介苗性淋巴結(jié)核AbstractObjectiveTosummarize19casesoftuberculouslymphadenitiscausedbyBCGvaccination,toexploretheetiology,clinicalfeatures,diagnosisandrationalandeffectivetreatmentMethods:AretrospectiveanalysisofBCGtuberculouslymphadenitisinourhospital.Summarizetheclinicalcharacteristics,surgicaltechnique,curativeeffectandprognosis

卡介苗性淋巴結(jié)核AbstractResults:9caseshavebeenmisdiagnosedinotherplaces,allchildrenhavebeencuredbysurgicalremovaloflymphnodelesions.Followedupfor5-24monthswithoutrecurrence.Conclusion:infantsvaccinatedipsilateralaxillarylymphnodetuberculosisislesscommon,itiseasilyleadtomisdiagnosisandwrongtreatment.Treatmentshouldbesurgicalexcision,preventionshouldbestrengthenedqualitycontrolandBCGvaccinationpersonneltrainingshouldbestandardoperation.卡介苗性淋巴結(jié)核ClinicdataThemedicalrecordsof19casesofarmpitmasswhichconfirmedtohavetubercularlymphnodeswereretrospectivelyreviewedfrom2003to2009.12casesweremaleand7females.Theaverageageonsetrangedfrom3to12months.Themajorcomplaintwerefindingalumpinleftarmpitwithahistoryof10—40days,anddiameteroflumpwere3—8centimeters.ThereisalsohavingBCGscarontheleftupperarm.3caseswerecuredwithisoniazid,however,thelumpwasnotobviouslydeflatedinotherinstitutions.卡介苗性淋巴結(jié)核Clinicdata2casesalreadyhaveredswellingandsurfaceulcerationontheskin.7caseshadcuredwithintravenouscephalosporinsantibioticsmorethan10days,Peripheralbloodregulartestsshowedtheleukocytecountwerebelow10×109/Lin8cases.9casesweremisdiagnosesaslymphomabeforeoperation.Allpatientswereneitherfevernorcough,andchestX-rayradiographwerenormal.Preoperativeultrasoundscansshowedsubstantialmassinleftampit.卡介苗性淋巴結(jié)核SurgicaltechniqueBasicketamineanaesthesiaplussevofluraneinhalation.Thechildrenwereinsupinepositionandwiththeirleftupperlimbabduction.Afterregularsterilizingofoperativelocalskin,alongwiththemacroaxisofmassafusiformincisionwereperformed.carefullyliftthesurfaceoftumoralongtheseparation,payattentionnottodamageimportantbloodvesselsandnerves.卡介苗性淋巴結(jié)核SurgicaltechniqueStopbleedingwhileCutting,encounteredcloselyadhesions,carefulsharpseparation,payattentiontoligation,metmultiplelobesmass,removalshallowlobe,andthendealwiththedeeper.whenmeetwithmultiplelymphnodeswellinglarge,removaloftumor-likelesionsenlargedlymphnodesaspossible,thewoundcavitywithnormalsalineflush,checknoactivebleeding,placedrainage,interruptablestitchweredonetoclosetheskinincisions卡介苗性淋巴結(jié)核ResultsandprognosisAllpetiantsweregivencephalosporinsantibioticstopreventwoundinfection.Drainageremoved2dayafteroperation.strengthernthedressinglymphnodesaftertumorpathologicallydiagnosedastuberculosis.Microscopically,thelymphnodestructureweredamaged,anumberoftypicaltuberculousnodules,somespecimenscanseesomeofthecentralcaseousnecrosisandcalcification.卡介苗性淋巴結(jié)核ResultsandprognosisThestitcheswereremovedandpatientsweredischarged7-10dayafteroperation.Soniazidewastakenorallyfor3monthsandpayattentiontoliverfunctionTherewasnocaseofsurgicalcomplicationsoccurredInadditiontopoorwoundhealingin2cases,andtheremaining17patientsincisionⅠofhealing,followedupfor5-24monthswithoutrecurrence.卡介苗性淋巴結(jié)核卡介苗性淋巴結(jié)核卡介苗性淋巴結(jié)核卡介苗性淋巴結(jié)核Discussion1BCGisanon-toxictypeofculturedMycobacteriumbovissuspension,wasmadefromattenuatedlivebacteria,tobecold-chaintransportandpreservation.BCGvaccinationiscarriedoutwiththeinitialinoculationattenuatedM.tuberculosisinfection,Aftermacrophageprocessing,informationtransfertheirantigenstotheimmuneactivityofcells,Tcellsdifferentiated,theformationofsensitizedlymphocytes.whenthebodyre-encountermycobacterialinfection,macrophagesandsensitizedlymphocytesrapidlyactivation,theimplementationofcellularimmunefunction,releaseoflymphokines,inducedspecificimmuneresponses.卡介苗性淋巴結(jié)核Discussion2Enlargementoflymphnodesafterinoculationwereregardasthestrongreactioninliterature,whileignoringsomecasesofformationoftuberculouslymphadenitis.Ifwefindenlargementofaxillarylymphnodes,weshouldpaymoreattentiontoremindofthisdisease.TheprognosisoftuberculouslymphadenitisduetovaccincationofBCGisdifferentfromgenerallocalreaction,thesclerosisisdiffculttoextinctbyitself.Themassscatteredandthenlong-termsinusformedwhichneedsurgicaltreatment.Forthisreasonmoremeasuresweretakentopreventitsoccurence.Someauthorsreportedthathotfomentationweretakentolymphadenectasis,ifthemassalreadysoftenandformedabscess,repeatlydrawingpuswithsterilizingsyringewereaexcellentmethod.IsoniazidepowderwasusedinulcercaseandIsoniazidewastakenorallyfor3monthsforcompletelycured..卡介苗性淋巴結(jié)核Discussion3Webelievethatrepeatedpuncturemaycauseinfection,oralisoniazidhaslittleeffect.3patientsweretreatedoutsidefor1monthoforalisoniazidhasnosignificaleffect.So,ifdiagnosiswasclear,lumpdiameterlargethan1cm,advisedtosurgeryresection,surgeryshouldbecarefullydissectedunderthearms,avoidharmingtheimportantnervesandbloodvessels,ligationofstumptissuesintimetopreventtheformationoflymphaticleakageafteroperation.Fortheearlystagesofdisease,lumpdiameterlessthan1cmwithoutsoftening,itpermitsforaperiodoftimetowaituntilafterthenaturalabsorption.Mostofthelymphaticlesionshavecleared,acco