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成人浅表淋巴结肿大的评估

Author
Robert H Fletcher, MD, MSc
Section Editor
Laurence A Boxer, MD
Deputy Editor
Jennifer S Tirnauer, MD
Translators
张宏丽, 主治医师

引言

在完成病史采集和体格检查后仍未发现明显病因的浅表淋巴结肿大使诊断陷入困境。一方面，存在无数潜在的病因，其中部分病因较为严重并且能被治疗。另一方面，严重的病因较为罕见，且获得确定性诊断的最好方法是活检，但活检具有侵入性且大多数病例没有充分理由采取活检。

成人淋巴结肿大患者的一般诊断方法将总结在此。颈部肿块(包括淋巴结肿大和其他病变)的评估和鉴别诊断参见其他专题。 (参见“颈部肿块的评估”和“颈部肿块的鉴别诊断”)

儿童淋巴结肿大的评估和治疗也将单独讨论。 (参见“儿童外周淋巴结肿大：评估与诊断方法”和“儿童颈部淋巴结炎的诊断方法和初始治疗”和“儿童周围淋巴结肿大：病因”和“儿童腹股沟肿胀的评估”)

解剖和定义

浅表淋巴结群位置概要显示如图(图 1和图 2)。正常淋巴结直径通常小于1cm，且在青春期时期往往较年长时偏大。健康人在腹股沟处常可触及淋巴结，可能是由于下肢的慢性创伤和感染相当常见，并且也可能在头颈部感染后于颈部触及淋巴结(尤其是下颌下区域)。

区分局部和全身淋巴结肿大可有助于确定鉴别诊断。临床上一种有用的方法是将仅累及1个区域(如，颈部或腋部)的淋巴结肿大归类为局部淋巴结肿大，以及将累及1个以上区域的淋巴结肿大归类为全身淋巴结肿大[1]。

                                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-13.
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