儿童不明原因颈部肿块病因及临床分析

Etiology and Clinical Analysis of Unexplained Neck Mass Diseases in Children

摘要: 目的：探讨不同病理类型儿童颈部肿块的临床特征，为疾病的早期诊断提供线索。方法：回顾分析经病理证实的颈部肿块患儿资料，分析不同病理类型的颈部肿块患儿的性别构成、年龄分布、淋巴结特征、临床表现及实验室检查等。采用单因素分析和多因素Logistic回归分析，筛选恶性淋巴结病的独立预测因素。结果：2019年10月~2021年05月，共110例患儿纳入研究计划，其中33例经病理证实颈部肿块为非淋巴结来源，其余77例颈部肿块均为淋巴结病，这其中良性淋巴结病51例(66%)，恶性淋巴结病26例(34%)。单因素分析发现年龄、发热、淋巴结触痛、淋巴结分布IV区、双侧颈部淋巴结受累、淋巴结最大直径、淋巴结短/长径比值、贫血、血小板计数、白细胞计数、血沉、乳酸脱氢酶水平是良恶性淋巴结病相关预测指标(P < 0.05)。多因素Logistic回归分析显示发热、淋巴结直径、淋巴结短/长径 > 0.5是恶性淋巴结病的独立影响因素(P < 0.05)。结论：儿童颈部肿块原因复杂，对于不伴发热的进行性淋巴结肿大，彩超提示淋巴结短/长径 > 0.5，提示为恶性淋巴结病可能，针对上述可疑恶性淋巴结病患儿，常规治疗效果欠佳时，应及时行淋巴结活检明确病因，制定科学的治疗方案。

Abstract: Objective: The objective is to explore the clinical features of neck mass diseases in children with different pathological types, and provide help to the early diagnosis of the disease. Methods: The data of children who underwent surgical excision and histopathological evaluation for persistently swollen neck mass diseases were collected, and the gender composition, age distribution, lymph node characteristics and clinical manifestations of children with different pathological types were analyzed. Univariate and multivariate analyses were made to determine independent predictors for malignancy. Results: Over a 1.5-year period (From October 2019 to May 2021), 110 children were included in our study. Thirty-three of cases have diseases mimicking lymphadenopathy; seven-ty-seven of cases have lymphadenopathy. The causes of lymphadenopathy were benign diseases in 51 patients (66%). Univariate analysis indicated that age, fever, distribution in areas IV, bilateral lymph involvement, lymph node size and tenderness, the ratio of maximal width to maximal length, anemia, blood platelet count, white blood cell count, erythrocyte sedimentation rate, lactate dehy-drogenase levels were important factors to predict the risk of malignancy in cervical lymph nodes (P < 0.05). Logistic regression analysis showed that fever, lymph node size, and the ratio of maximal width to maximal length > 0.5 (ratio) were independent risk factors associated with malignant dis-ease. Conclusion: The causes of cervical masses in children are complicated. For progressive lym-phadenopathy without fever, color Doppler ultrasound indicates that the short/long diameter of lymph nodes is > 0.5, suggesting that it may be malignant lymphadenopathy. For the above-mentioned children with suspected malignant lymphadenopathy, when the conventional treatment is not effective, lymph node biopsy should be performed in time to identify the cause and formulate a scientific treatment plan.