頸部結核性リンパ節炎の外科

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Seventy one surgical treatment was carried out for 67 patients with tuberculous cervical lympha-denitis during the last 10 years (1969-1978) in our hospital. Although the morbidity rate at the national level has been decreasing gradually, there was no decline in the number of our cases throughout this period. Most of them did not show typical local inflammatory symptoms, and characteristic conglomer-ation as recognized in no more than about half of cases and abscess formation in about 40%. They were mostly involved hemilaterally and the upper cervical nodes were involved a little more than the lower ones. In spite of the sufficient treatment with anti-tuberculous drugs, one-third of all cases showed worsening of local signs. Active pulmonary tuberculosis was found in 61.2% on chest X-ray and there were 10 cases combined with tuberculous lymphadenitis in other sites. Surgical procedures of treatments were the incision alone for 12 cases, the simple resection of a swollen node for 34 cases, the radical dissection for 24 cases and the curettage for 1 case. Of these, the incision was employed for 28 cases primarily, but the second radical operation was necessary for 18 cases within 3 months. Operative wounds healed almost completely with sufficient post operative anti-tuberculous chemo-therapy, and the recurrence rate was 5.3% during 2 years after the surgical treatment. The cultures of tuberculous bacilli in involved lymphnodes showed positive in only 20.6% of all examined cases. On the other hand, typical tuberculous lesions were pathohistologically demonstrated in 84% of examined cases. The preoperative anti-tuberculous chemotherapy for more than 3 months was significantly effective on the culture positive rate of tubercle bacilli especially in caseous lesions. Dur-ing the follow-up, 5 recurrent cases were found until the end of 1979. Common factors of them were recognized as follows: Preoperative chemotherapy was shorter than 3 months (4/5), positive culture of tubercle bacilli in lymphnodes (4/5) and simple resection of a swollen node (3/5). Contrary to our expectation, no significant relation was recognized concerning the duration of postoperative anti-tuberculous chemotherapy. From these results, we conclude that the surgical treatment for tuberculous cervical lymphadenitis should be performed to truly indicated cases with the sufficient postoperative anti-tuberculosis chemotherapy for more than 6 months. Even in such cases, it is advisable to give effective anti-tuberculous chemotherapy for more than 3 months before the operation.

頸部結核性リンパ節炎の外科

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