目的:回顾专门研究临床数据的科学医学文献,自21世纪初以来发表的喉结结核的诊断和治疗。
方法:搜索Medline,2000-2022年期间的Cochrane和Embase数据库。选择记录临床数据的队列和病例报告,喉结核的诊断和治疗。
结果:总计,对119篇文章进行了分析。免疫抑制,HIV感染,肺结核史,一般症状提示肺结核,18%的人注意到吸烟和相关的喉癌,3%,20%和41%的病例,分别。未出现病理性症状或体征。语音障碍,各种类型和严重性,隔离和/或与其他迹象相关,是最常见的喉部症状,在86%的案例中。所有喉部都受累,与众多不同的协会。在6%和1%的病例中注意到喉活动受损和气管切开术,分别。诊断时间从不到1个月到36个月不等,平均3个月,在案例报告中。28%的病例在细菌学上确定诊断为喉结核,而在其他72%的病例中,诊断是基于间接标准和/或涉及另一个部位。54%的肺部受累。治疗持续时间为6至24个月(中位数,6个月),使用3至5种(中位数:4)抗结核抗生素,其中4例用于80%的队列和77%的病例报告。总体治愈率,死亡,治疗抗性,不良事件,喉后遗症占99%,0.5%,0.5%,6%和5%,分别。
结论:自20世纪末以来,喉结核的临床表现和诊断难度没有改变。四合疗法非常有效,耐药率低,不良反应或喉后遗症少。
OBJECTIVE: Review of the scientific medical literature dedicated to clinical data, diagnosis and treatment for laryngeal tuberculosis published since the turn of the 21st century.
METHODS: Search of the Medline, Cochrane and Embase databases for the period 2000-2022. Selection of cohorts and case reports documenting clinical data, diagnosis and treatment for laryngeal tuberculosis.
RESULTS: In total, 119 articles were analyzed. Immunodepression, HIV infection, history of lung tuberculosis, general symptoms suggesting tuberculosis, smoking and associated laryngeal cancer were noted in 18%, 3%, 20% and 41% of cases, respectively. No pathognomonic symptoms or signs emerged. Voice impairment, of various types and severity, isolated and/or associated with other signs, was the most frequent laryngeal symptom, in 86% of cases. All laryngeal sites were involved, with numerous and various associations. Impaired laryngeal motion and tracheotomy were noted in 6% and 1% of cases, respectively. Time to diagnosis varied from less than 1month to 36months, for a median 3months, in case reports. Laryngeal tuberculosis was diagnosed bacteriologically with certainty in 28% of cases while diagnosis was based on indirect criteria and/or involvement of another site in the other 72%, with lung involvement in 54%. Treatment duration ranged from 6 to 24months (median, 6months), using 3 to 5 (median: 4) antitubercular antibiotics, with 4 used in 80% of cohorts and 77% of case reports. Overall rates of cure, death, treatment resistance, adverse events, and laryngeal sequelae were 99%, 0.5%, 0.5%, 6% and 5%, respectively.
CONCLUSIONS: The clinical presentation and diagnostic difficulty in laryngeal tuberculosis did not change since the end of the 20th century. Quadritherapy is highly effective, with a low resistance rate and few adverse effects or laryngeal sequelae.