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摘要: 目的 探讨以头颈部症状为主的结节病的临床特点，并总结其诊治经验。方法 回顾性纳入2020年1月-2023年8月于河南省人民医院就诊的以头颈部症状为主的结节病患者，分析其症状特点、病理学特征、治疗方式及预后情况等临床资料。结果 共纳入14例患者，其中男4例(28.6%)，女10例(71.4%)；年龄11~71岁，平均(52.0±15.8)岁。病变位于腮腺2例，颈部12例。12例行颈部肿物切除术，2例行超声引导下腮腺肿物粗针穿刺术，术后均经病理明确诊断。4例术后辅以激素治疗，术后3个月预后良好，病变范围缩小；3例未服用药物，病变持续存在，仍感不适；7例术后未服用药物，病变范围扩大，多器官进展。结论 头颈部结节病的患者临床少见，容易漏诊、误诊，选用激素治疗可获得良好疗效。Abstract: Objective To explore the clinical characteristics of sarcoidosis of head and neck symptoms, and to summarize the diagnosis and treatment experience.Methods A retrospective study was conducted on patients with nodular disease with main symptoms in the head and neck who visited Henan Provincial People's Hospital from January 2020 to August 2023. The clinical data including symptom characteristics, pathological characteristics, treatment methods, and prognosis were analyzed.Results A total of 14 patients were included, with 4 males(28.6%) and 10 females(71.4%), age ranged from 11 to 71 years, with an average age of(52.0±15.8) years. The lesions were located in the parotid gland in 2 cases and the neck in 12 cases. Twelve cases underwent neck mass resection surgery, and 2 cases underwent ultrasound-guided core biopsy of parotid gland tumor and postoperative pathological diagnosis was confirmed in all cases. Four cases received steroid treatment postoperatively, and showed good prognosis with reduced lesion size after 3 months. Three cases did not take medication and the lesions continued to persist, causing discomfort. Seven cases did not take medication postoperatively, and the lesions expanded with multi-organ progression.Conclusion Patients with head and neck sarcoidosis are rare in clinical practice, and it is prone to misdiagnosis and missed diagnosis. Steroid therapy can achieve good therapeutic effects.
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Key words:
- sarcoidosis of head and neck /
- clinical features /
- diagnostic experience /
- prognosis
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表 1 14例头颈部结节病患者的临床表现
例序 性别 年龄/岁 主要症状 其他症状 1 女 69 左侧腮腺区肿物 无 2 女 56 双侧颈部肿物 无 3 女 51 双侧颈部肿物 无 4 女 48 左侧颈部肿物 无 5 男 27 右侧颈部肿物 无 6 男 53 左侧后颈部肿物 无 7 女 64 双侧颈部肿物 无 8 女 47 双侧颈部肿物 全身关节红肿、疼痛 9 女 71 右侧颈部肿物 胸闷、气促 10 女 52 左侧颈部肿物 胸闷、气促 11 男 11 双侧颈部肿物 腹部不适 12 女 52 右侧颈部肿物 发热 13 女 69 右侧颈部肿物 无 14 男 58 双侧腮腺肥大 无 
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表 2 14例头颈部结节病的免疫组织化学检测结果
检测结果 AE1/AE3 CD163 CD68 CD1a CD3 CD20 CD21 CD30 CD4 Langerin Napsin A TTF-1 S-100 Ki-67 合计/例 6 8 8 3 8 8 8 2 8 6 6 6 5 7 阳性/例 5 8 8 1 8 8 8 1 8 0 0 0 1 4 阴性/例 1 0 0 2 0 0 0 1 0 6 6 6 4 3 阳性率/% 83.3 100.0 100.0 33.3 100.0 100.0 100.0 50.0 100.0 0 0 0 20.0 57.1 注：AE1/AE3：多细胞角蛋白1/3；CD：白细胞分化抗原；Ki-67：增殖细胞核抗原。
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表 3 14例头颈部结节病患者的治疗及预后
例序 药物选择 术前病变部位 术后病变部位及范围 1 泼尼松 双侧腮腺 部位同前，病变范围较前缩小 2 无 右颈部+纵隔+左肺部+腹膜后 部位同前，病变范围病变无进展 3 无 双侧颈部+腋窝+腹股沟 双侧颈部+腋窝+腹股沟+肺部 4 无 双侧颈部+左肺上叶 双侧颈部+肺部+纵隔 5 无 双侧颈部+腋窝+纵隔+肺部+肝脾 部位同前，病变范围病变无进展 6 无 左颈部 双侧颈部 7 无 双侧颈部 双侧颈部+腋窝+肺部 8 甲泼尼龙+吗替麦考酚酯 双侧颈部+腋窝 部位同前，病变范围较前缩小 9 甲泼尼龙 双侧颈根部+纵隔+双侧肺门+双侧胸膜 部位同前，病变范围较前缩小 10 泼尼松 左侧锁骨+胸部+双侧胸膜 部位同前，病变范围较前缩小 11 无 双侧颈根部+纵隔+腹股沟 双侧胸膜+肺部+纵隔+颈根部+腹股沟 12 无 右颈部+双侧肺部 右颈部+双侧肺部+左侧胸膜 13 无 右颈部 右颈部+双侧肺部 14 无 双侧腮腺 部位同前，病变无进展
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