卡介苗性淋巴结核

1、小儿卡介苗性淋巴结核的外科治疗小儿卡介苗性淋巴结核的外科治疗Surgical treatment of tuberculous lymphadenitis caused by BCG vaccination in infants 小儿外科小儿外科 柳柳 宏宏 金兴硕金兴硕 连树华连树华Introduction of BCGvBCG is the acronym for Bacillus Calmette Gurin, Bacillus is the meaning of Bacteria, Calmette and Gurin are both French scientist, after

2、13 years of subculture, they got an attenuated strain BCG, can be used to prevent TB infection, in chinese named as kajiemiao.v BCG vaccination known as the first injection of newborn, in the lateral upper arm deltoid 0.1ml intradermal injection . BCG vaccination of children is very good for the hea

3、lthy growth.The use of BCGvThe original for the prevention of tuberculosis as a specific immune agent.vIt also has function to promote macrophage phagocytosis as a non-specific immune enhancer. vIt is used in treatment of malignant melanoma, or lung cancer, acute leukemia, malignant lymphoma after r

4、adical surgery or chemotherapy as adjuvant treatment.vIt were also received some effects of BCG therapy with pediatric asthma, bronchitis, pediatric flu prevention and the prevention and treatment of adult chronic bronchitis.Response after vaccination vAfter BCG vaccination of about 1 to 2 weeks, th

5、e local section will show the red knot, then gradually grew up, a slight itching, but not fever; 6 to 8 weeks to form pus bubbles or ulceration; 10 to 12 weeks began to scab, After the scab off leaving a small reddish scars, after the red color gradually became normal.vSwollen lymph glands would eme

6、rge as abnormal reactions, mainly related to personal physical fitness, the more vulnerable younger vaccination, also with the type of vaccination or inoculation too deep, such as vaccination in the skin.vAlthough BCG has played an important role in preventing TB in children, with the universal vacc

7、ination of BCG, a small number of children showed enlargement of axillary lymph nodes in vaccinated side, even become the TB mass, deserves our attention. AbstractvObjective To summarize 19 cases of tuberculous lymphadenitis caused by BCG vaccination, to explore the etiology, clinical features, diag

8、nosis and rational and effective treatment vMethods: A retrospective analysis of BCG tuberculous lymphadenitis in our hospital. Summarize the clinical characteristics, surgical technique, curative effect and prognosis AbstractvResults: 9 cases have been misdiagnosed in other places, all children hav

9、e been cured by surgical removal of lymph node lesions. Followed up for 5 - 24 months without recurrence.vConclusion: infants vaccinated ipsilateral axillary lymph node tuberculosis is less common, it is easily lead to misdiagnosis and wrong treatment. Treatment should be surgical excision, preventi

10、on should be strengthened quality control and BCG vaccination personnel training should be standard operation.Clinic datavThe medical records of 19 cases of armpit mass which confirmed to have tubercular lymph nodes were retrospectively reviewed from 2003 to 2009. v12 cases were male and 7 females.

11、The average age onset ranged from 3 to 12months.vThe major complaint were finding a lump in left armpit with a history of 1040 days, and diameter of lump were 38 centimeters.vThere is also having BCG scar on the left upper arm. v3 cases were cured with isoniazid,however, the lump was not obviously d

12、eflated in other institutions .Clinic datav2 cases already have red swelling and surface ulceration on the skin. v7 cases had cured with intravenous cephalosporins antibiotics more than 10 days,vPeripheral blood regular tests showed the leukocyte count were below 10109/L in 8 cases. v9 cases were mi

13、sdiagnoses as lymphoma before operation. vAll patients were neither fever nor cough, and chest X-ray radiograph were normal.vPreoperative ultrasound scans showed substantial mass in left ampit. Surgical techniquevBasic ketamine anaesthesia plus sevoflurane inhalation.vThe children were in supine pos

14、ition and with their left upper limb abduction. After regular sterilizing of operative local skin, along with the macroaxis of mass a fusiform incision were performed. carefully lift the surface of tumor along the separation, pay attention not to damage important blood vessels and nerves.Surgical te

15、chniquevStop bleeding while Cutting, encountered closely adhesions, careful sharp separation, pay attention to ligation, met multiple lobes mass, removal shallow lobe, and then deal with the deeper.vwhen meet with multiple lymph node swelling large, removal of tumor-like lesions enlarged lymph nodes

16、 as possible, the wound cavity with normal saline flush, check no active bleeding, place drainage, interruptable stitch were done to close the skin incisionsResults and prognosisvAll petiants were given cephalosporins antibiotics to prevent wound infection. Drainage removed 2 day after operation. st

17、rengthern the dressingvlymph nodes after tumor pathologically diagnosed as tuberculosis. Microscopically, the lymph node structure were damaged, a number of typical tuberculous nodules, some specimens can see some of the central caseous necrosis and calcification.Results and prognosisvThe stitches w

18、ere removed and patients were discharged 7-10 day after operation. vSoniazide was taken orally for 3 months and pay attention to liver function vThere was no case of surgical complications occurredvIn addition to poor wound healing in 2 cases, and the remaining 17 patients incision of healing, follo

19、wed up for 5 - 24 months without recurrence.Discussion1vBCG is a non-toxic type of cultured Mycobacterium bovis suspension, was made from attenuated live bacteria, to be cold-chain transport and preservation.vBCG vaccination is carried out with the initial inoculation attenuated M. tuberculosis infe

20、ction, vAfter macrophage processing, information transfer their antigens to the immune activity of cells, T cells differentiated, the formation of sensitized lymphocytes.v when the body re-encounter mycobacterial infection, macrophages and sensitized lymphocytes rapidly activation, the implementatio

21、n of cellular immune function, release of lymphokines, induced specific immune responses.Discussion2vEnlargement of lymph nodes after inoculation were regard as the strong reaction in literature, while ignoring some cases of formation of tuberculous lymphadenitis. If we find enlargement of axillary

22、lymph nodes, we should pay more attention to remind of this disease.vThe prognosis of tuberculous lymphadenitis due to vaccincation of BCG is different from general local reaction, the sclerosis is diffcult to extinct by itself. vThe mass scattered and then long-term sinus formed which need surgical

23、 treatment. For this reason more measures were taken to prevent its occurence.vSome authors reported that hot fomentation were taken to lymphadenectasis, if the mass already soften and formed abscess, repeatly drawing pus with sterilizing syringe were a excellent method. vIsoniazide powder was used

24、in ulcer case and Isoniazide was taken orally for 3 months for completely cured. *. Discussion3vWe believe that repeated puncture may cause infection, oral isoniazid has little effect. 3 patients were treated outside for 1 month of oral isoniazid has no significal effect.v So, if diagnosis was clear

25、, lump diameter large than 1 cm, advised to surgery resection, surgery should be carefully dissected under the arms, avoid harming the important nerves and blood vessels, ligation of stump tissues in time to prevent the formation of lymphatic leakage after operation.vFor the early stages of disease, lump diameter less than1 cm without softening, it permits for a period of time to wait until after the natural absorption.vMost of the lymphatic lesio