卡介苗性淋巴结核.ppt

小儿卡介苗性淋巴结核的外科治疗SurgicaltreatmentoftuberculouslymphadenitiscausedbyBCGvaccinationininfants小儿外科柳宏金兴硕连树华 IntroductionofBCG BCGistheacronymforBacillusCalmetteGu rin BacillusisthemeaningofBacteria CalmetteandGu rinarebothFrenchscientist after13yearsofsubculture theygotanattenuatedstrainBCG canbeusedtopreventTBinfection inchinesenamedaskajiemiao BCGvaccinationknownasthefirstinjectionofnewborn inthelateralupperarmdeltoid0 1mlintradermalinjection BCGvaccinationofchildrenisverygoodforthehealthygrowth TheuseofBCG Theoriginalforthepreventionoftuberculosisasaspecificimmuneagent Italsohasfunctiontopromotemacrophagephagocytosisasanon specificimmuneenhancer Itisusedintreatmentofmalignantmelanoma orlungcancer acuteleukemia malignantlymphomaafterradicalsurgeryorchemotherapyasadjuvanttreatment ItwerealsoreceivedsomeeffectsofBCGtherapywithpediatricasthma bronchitis pediatricflupreventionandthepreventionandtreatmentofadultchronicbronchitis Responseaftervaccination AfterBCGvaccinationofabout1to2weeks thelocalsectionwillshowtheredknot thengraduallygrewup aslightitching butnotfever 6to8weekstoformpusbubblesorulceration 10to12weeksbegantoscab Afterthescaboffleavingasmallreddishscars aftertheredcolorgraduallybecamenormal Swollenlymphglandswouldemergeasabnormalreactions mainlyrelatedtopersonalphysicalfitness themorevulnerableyoungervaccination alsowiththetypeofvaccinationorinoculationtoodeep suchasvaccinationintheskin AlthoughBCGhasplayedanimportantroleinpreventingTBinchildren withtheuniversalvaccinationofBCG asmallnumberofchildrenshowedenlargementofaxillarylymphnodesinvaccinatedside evenbecometheTBmass deservesourattention Abstract ObjectiveTosummarize19casesoftuberculouslymphadenitiscausedbyBCGvaccination toexploretheetiology clinicalfeatures diagnosisandrationalandeffectivetreatmentMethods AretrospectiveanalysisofBCGtuberculouslymphadenitisinourhospital Summarizetheclinicalcharacteristics surgicaltechnique curativeeffectandprognosis Abstract Results 9caseshavebeenmisdiagnosedinotherplaces allchildrenhavebeencuredbysurgicalremovaloflymphnodelesions Followedupfor5 24monthswithoutrecurrence Conclusion infantsvaccinatedipsilateralaxillarylymphnodetuberculosisislesscommon itiseasilyleadtomisdiagnosisandwrongtreatment Treatmentshouldbesurgicalexcision preventionshouldbestrengthenedqualitycontrolandBCGvaccinationpersonneltrainingshouldbestandardoperation Clinicdata Themedicalrecordsof19casesofarmpitmasswhichconfirmedtohavetubercularlymphnodeswereretrospectivelyreviewedfrom2003to2009 12casesweremaleand7females Theaverageageonsetrangedfrom3to12months Themajorcomplaintwerefindingalumpinleftarmpitwithahistoryof10 40days anddiameteroflumpwere3 8centimeters ThereisalsohavingBCGscarontheleftupperarm 3caseswerecuredwithisoniazid however thelumpwasnotobviouslydeflatedinotherinstitutions Clinicdata 2casesalreadyhaveredswellingandsurfaceulcerationontheskin 7caseshadcuredwithintravenouscephalosporinsantibioticsmorethan10days Peripheralbloodregulartestsshowedtheleukocytecountwerebelow10 109 Lin8cases 9casesweremisdiagnosesaslymphomabeforeoperation Allpatientswereneitherfevernorcough andchestX rayradiographwerenormal Preoperativeultrasoundscansshowedsubstantialmassinleftampit Surgicaltechnique Basicketamineanaesthesiaplussevofluraneinhalation Thechildrenwereinsupinepositionandwiththeirleftupperlimbabduction Afterregularsterilizingofoperativelocalskin alongwiththemacroaxisofmassafusiformincisionwereperformed carefullyliftthesurfaceoftumoralongtheseparation payattentionnottodamageimportantbloodvesselsandnerves Surgicaltechnique StopbleedingwhileCutting encounteredcloselyadhesions carefulsharpseparation payattentiontoligation metmultiplelobesmass removalshallowlobe andthendealwiththedeeper whenmeetwithmultiplelymphnodeswellinglarge removaloftumor likelesionsenlargedlymphnodesaspossible thewoundcavitywithnormalsalineflush checknoactivebleeding placedrainage interruptablestitchweredonetoclosetheskinincisions Resultsandprognosis Allpetiantsweregivencephalosporinsantibioticstopreventwoundinfection Drainageremoved2dayafteroperation strengthernthedressinglymphnodesaftertumorpathologicallydiagnosedastuberculosis Microscopically thelymphnodestructureweredamaged anumberoftypicaltuberculousnodules somespecimenscanseesomeofthecentralcaseousnecrosisandcalcification Resultsandprognosis Thestitcheswereremovedandpatientsweredischarged7 10dayafteroperation Soniazidewastakenorallyfor3monthsandpayattentiontoliverfunction TherewasnocaseofsurgicalcomplicationsoccurredInadditiontopoorwoundhealingin2cases andtheremaining17patientsincision ofhealing followedupfor5 24monthswithoutrecurrence Discussion1 BCGisanon toxictypeofculturedMycobacteriumbovissuspension wasmadefromattenuatedlivebacteria tobecold chaintransportandpreservation BCGvaccinationiscarriedoutwiththeinitialinoculationattenuatedM tuberculosisinfection Aftermacrophageprocessing informationtransfertheirantigenstotheimmuneactivityofcells Tcellsdifferentiated theformationofsensitizedlymphocytes whenthebodyre encountermycobacterialinfection macrophagesandsensitizedlymphocytesrapidlyactivation theimplementationofcellularimmunefunction releaseoflymphokines inducedspecificimmuneresponses Discussion2 Enlargementoflymphnodesafterinoculationwereregardasthestrongreactioninliterature whileignoringsomecasesofformationoftuberculouslymphadenitis Ifwefindenlargementofaxillarylymphnodes weshouldpaymoreattentiontoremindofthisdisease TheprognosisoftuberculouslymphadenitisduetovaccincationofBCGisdifferentfromgenerallocalreaction thesclerosisisdiffculttoextinctbyitself Themassscatteredandthenlong termsinusformedwhichneedsurgicaltreatment Forthisreasonmoremeasuresweretakentopreventitsoccurence Someauthorsreportedthathotfomentationweretakentolymphadenectasis ifthemassalreadysoftenandformedabscess repeatlydrawingpuswithsterilizingsyringewereaexcellentmethod IsoniazidepowderwasusedinulcercaseandIsoniazidewastakenorallyfor3monthsforcompletelycured Discussion3 Webelievethatrepeatedpuncturemaycauseinfection oralisoniazidhaslittleeffect 3patientsweretreatedoutsidefor1monthoforalisoniazidhasnosignificaleffect So ifdiagnosiswasclear lumpdiameterlargethan1cm advisedtosurgeryresection surgeryshouldbecarefullydissectedunderthearms avoidharmingtheimportantnervesandbloodvessels ligationofstumptissuesintimetopreventtheformationoflymphaticleakageafteroperation Fortheearlystagesofdisease lumpdiameterlessthan1cmwithoutsoftening itpermitsforaperiodoftimetowaituntilafterthenaturalabsorption Mostofthelymphaticlesionshaveclea