卡介苗性淋巴结核课件

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卡介苗性淋巴结核IntroductionofBCGBCGistheacronymforBacillusCalmetteGuérin,BacillusisthemeaningofBacteria,CalmetteandGuérinarebothFrenchscientist,after13yearsofsubculture,theygotanattenuatedstrainBCG,canbeusedtopreventTBinfection,inchinesenamedaskajiemiao.BCGvaccinationknownasthefirstinjectionofnewborn,inthelateralupperarmdeltoid0.1mlintradermalinjection.BCGvaccinationofchildrenisverygoodforthehealthygrowth.卡介苗性淋巴结核TheuseofBCGTheoriginalforthepreventionoftuberculosisasaspecificimmuneagent.Italsohasfunctiontopromotemacrophagephagocytosisasanon-specificimmuneenhancer.Itisusedintreatmentofmalignantmelanoma,orlungcancer,acuteleukemia,malignantlymphomaafterradicalsurgeryorchemotherapyasadjuvanttreatment.ItwerealsoreceivedsomeeffectsofBCGtherapywithpediatricasthma,bronchitis,pediatricflupreventionandthepreventionandtreatmentofadultchronicbronchitis.卡介苗性淋巴结核ResponseaftervaccinationAfterBCGvaccinationofabout1to2weeks,thelocalsectionwillshowtheredknot,thengraduallygrewup,aslightitching,butnotfever;6to8weekstoformpusbubblesorulceration;10to12weeksbegantoscab,Afterthescaboffleavingasmallreddishscars,aftertheredcolorgraduallybecamenormal.Swollenlymphglandswouldemergeasabnormalreactions,mainlyrelatedtopersonalphysicalfitness,themorevulnerableyoungervaccination,alsowiththetypeofvaccinationorinoculationtoodeep,suchasvaccinationintheskin.卡介苗性淋巴结核AlthoughBCGhasplayedanimportantroleinpreventingTBinchildren,withtheuniversalvaccinationofBCG,asmallnumberofchildrenshowedenlargementofaxillarylymphnodesinvaccinatedside,evenbecometheTBmass,deservesourattention.卡介苗性淋巴结核AbstractObjectiveTosummarize19casesoftuberculouslymphadenitiscausedbyBCGvaccination,toexploretheetiology,clinicalfeatures,diagnosisandrationalandeffectivetreatmentMethods:AretrospectiveanalysisofBCGtuberculouslymphadenitisinourhospital.Summarizetheclinicalcharacteristics,surgicaltechnique,curativeeffectandprognosis

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