颈淋巴结结核患者临床特征及术后复发的影响因素分析

doi:10.19871/j.cnki.xfcrbzz.2026.04.009

摘要/Abstract

摘要： 目的探讨颈淋巴结结核患者的临床特征,分析影响其手术治疗后病灶复发的影响因素,为颈淋巴结结核患者临床诊疗提供参考。方法回顾性分析2019年6月至2025年4月在广州市胸科医院行手术治疗的707例颈淋巴结结核患者的临床资料,对患者性别、年龄、病变部位、病变类型、淋巴结大小、颈淋巴结分区累及数量以及合并症等指标进行统计分析,通过卡方检验比较不同组间样本率差异。采用多因素Logistic回归分析颈淋巴结结核患者手术治疗后复发的影响因素。结果患者男女比例为1∶1.69;未成年、青年、中年、老年患者的占比分别为6.4%、75.3%、14.6%和4.6%。患者共合并13种基础疾病,以肺结核最为常见,共379例患者合并肺结核。病灶分布于左侧颈部210例、右侧颈部246例、双侧颈部230例、颈前区21例。病变类型涵盖结节型64例、浸润型124例、脓肿型398例、溃疡型121例。根据病灶内最大淋巴结的最大径进行分组统计,其中最大径<1.8cm者172例,1.8~3.3cm者368例,>3.3cm者167例。病灶累及1个颈淋巴结分区289例、2个224例、3个100例、≥4个94例。结节型、浸润型、脓肿型、溃疡型患者术后复发率分别为1.56%（1/64）、1.61%（2/124）、19.60%（78/398）、12.40%（15/121）,组间差异有统计学意义（χ²=35.437,P<0.001）;病灶累及1、2、3、≥4个颈淋巴结分区的患者术后复发率分别为7.61%（22/289）、11.16%（25/225）、20.00%（20/100）、30.85%（29/94）,组间差异有统计学意义（χ²=37.294,P<0.001）。多因素Logistic回归分析结果表明,脓肿型、溃疡型病变及病灶累及≥3个颈淋巴结分区为术后复发的独立危险因素（均OR>1,均P<0.05）。结论颈淋巴结结核在青年人群中高发,肺结核为其主要合并症,脓肿型、溃疡型和病灶累及≥3个颈淋巴结分区的患者术后复发风险增加。

关键词: 颈淋巴结结核, 临床特征, 术后复发, 影响因素, 回顾性分析, 手术治疗

Abstract: Objective To explore the clinical characteristics of patients with cervical lymph node tuberculosis, analyze the influencing factors of lesion recurrence after surgical treatment, and provide evidence for clinical diagnosis and treatment of cervical lymph node tuberculosis. Method A retrospective analysis was performed on the clinical data of 707 patients with cervical lymph node tuberculosis who underwent surgical treatment in Guangzhou Chest Hospital from June 2019 to April 2025. Clinical indicators including gender, age, lesion location, pathological type, lymph node size, number of involved cervical lymph node regions, and complications were statistically analyzed. The chi-square test was used to compare the differences in sample rates among different groups. Multivariate Logistic regression analysis was applied to identify the factors affecting postoperative recurrence in patients with cervical lymph node tuberculosis. Result The male-to-female ratio of the patients was 1∶1.69, and the proportions of minor, young, middle-aged and elderly patients were 6.4%, 75.3%, 14.6% and 4.6%, respectively. A total of 13 types of underlying comorbidities were identified, among which pulmonary tuberculosis was the most common, occurring in 379 patients. In terms of lesion distribution, 210 cases were located in the left neck, 246 in the right neck, 230 in the bilateral neck, and 21 in the anterior cervical region. The pathological types included nodular type (64 cases), infiltrative type (124 cases), abscess type (398 cases), and ulcerative type (121 cases). All patients were grouped according to the maximum diameter of the largest lymph node in the lesion. Among them, 172 cases had a maximum diameter of less than 1.8 cm, 368 cases of 1.8-3.3 cm, and 167 cases of more than 3.3 cm. Regarding the number of involved cervical lymph node regions, 289 cases involved 1 region, 224 involved 2 regions, 100 involved 3 regions, and 94 involved ≥4 regions. The postoperative recurrence rates of nodular, infiltrative, abscess, and ulcerative types were 1.56% (1/64), 1.61% (2/124), 19.60% (78/398), and 12.40% (15/121), respectively, with statistically significant differences among groups (χ²=35.437, P<0.001). The postoperative recurrence rates of patients with lesions involving 1, 2, 3, and ≥4 cervical lymph node regions were 7.61% (22/289), 11.16% (25/225), 20.00% (20/100), and 30.85% (29/94), respectively, and the differences were statistically significant (χ²=37.294, P<0.001). Multivariate Logistic regression analysis demonstrated that abscess type, ulcerative type, and involvement of ≥3 cervical lymph node regions were independent risk factors for postoperative recurrence (all OR>1, all P<0.05). Conclusion Cervical lymph node tuberculosis is highly prevalent in young adults, and pulmonary tuberculosis is its primary comorbidity. Patients with abscess-type or ulcerative lesions and involvement of ≥3 cervical lymph node regions have an increased risk of postoperative recurrence.

Key words: Cervical lymph node tuberculosis, Clinical characteristics, Postoperative recurrence, Influencing factors, Retrospective analysis, Surgical treatment

中图分类号:

R552

方宇辰, 陈晓辉, 石伟成, 陈卓宏, 邵琤, 刘曾维, 游佩涛. 颈淋巴结结核患者临床特征及术后复发的影响因素分析[J]. 新发传染病电子杂志, 2026, 11(4): 57-62.

Fang Yuchen, Chen Xiaohui, Shi Weicheng, Chen Zhuohong, Shao Cheng, Liu Zengwei, You Peitao. Analysis of clinical characteristics and influencing factors of postoperative recurrence in patients with cervical lymph node tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(4): 57-62.

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