评论
打印
Introduction (Approach to Neck Masses)
介绍（颈部肿块的治疗方法）
A variety of diseases could present as a lump or mass in the neck.
许多疾病都可能表现为颈部的肿块或结节。
These could be inflammatory, congenital, or neoplastic lesions.
这些可能是炎症性病变、先天性病变或肿瘤性病变。
Whenever a patient presents with a neck mass, it requires some work up, especially if a malignant neoplasm (i.e. cancer) is suspected.
每当患者出现颈部肿块时，就需要做一些检查，特别是如果怀疑是恶性肿瘤(即癌症)。
Basic anatomy
基础解剖学
Work up for neck masses requires a basic understanding of the structure of the neck and at which level they lie.
处理颈部肿块需要对颈部的结构和位置有一个基本的了解。
One way to localize the different structures is to divide the neck into a number of triangles.
一种定位不同结构的方法是将颈部分成若干三角形。
Another way to define location is the levels system.
另一种定义位置的方法是等级系统。
This system is especially useful when defining enlarged lymph nodes in the neck.
该系统在确定颈部肿大的淋巴结时特别有用。
Lymph node groups and their respective regions in the neck are assigned numbers from level 1 to level 7.
颈部的淋巴结组及其相应区域按1级至7级编号。
It is important to note that lymphatic drainage from the entire head and neck goes into the neck nodes.
值得注意的是，整个头部和颈部的淋巴会引流进入颈部淋巴结。
Sometimes, diseases in the abdomen could also travel to the neck nodes.
有时，腹部疾病也会蔓延到颈部淋巴结。
This means that if there is an infection or cancer, especially in the head region, can easily lead to lymph node enlargement in the neck.
这意味着，如果有感染或癌症，特别是在头部区域，很容易导致颈部淋巴结肿大。
Finally, the simplest way to define neck masses is to divide them into midline or lateral neck masses.
最后，定义颈部肿块的最简单方法是将其分为颈部中线肿块或外侧肿块。
The examination
检查
Once the patient presents with a neck mass, the main concern for the physician is whether the mass is neoplastic (i.e. cancerous) or not.
一旦患者出现颈部肿块，医生主要关心的是肿块是否为肿瘤(即癌)。
Here are some important points to note in the patient’s history: What is the age of the patient.
以下是病人病史上需要注意的一些重要事项：病人的年龄。
Neck mass in patient less than 35 years is unlikely to be a malignant cancer.
年龄在35岁以下的患者颈部肿块不太可能是恶性肿瘤。
How long has the mass been present?
肿块出现多久了？
If it is present for more than 3 weeks, then there is a suspicion for neoplasia or tuberculosis but if it is less than 2 weeks, then it is most likely infective lymphadenitis.
如果出现时间超过3周，则可能是肿瘤或肺结核，但如果出现时间少于2周，则最有可能是感染性淋巴结炎。
Is the neck mass painful or tender?
颈部肿块是疼痛还是压痛？
Pain and tenderness are generally features of infections or physical trauma.
疼痛和压痛通常是感染或身体创伤的特征。
In contrast, neoplastic lesions may be painless.
相比之下，肿瘤病变可能是无痛感的。
What are the associated features?
有哪些相关症状？
Is there toothache, sore throat or odynophagia?
有牙痛、喉咙痛或吞咽疼痛吗？
Is there associated hoarseness, dysphagia, weight loss, night sweats or fever?
是否伴有声音嘶哑、吞咽困难、体重减轻、盗汗或发烧？
Is there any history of tobacco use?
有没有吸烟史？
Any irradiation of the neck?
颈部有没有受过辐射？
Has there been any contact with pets?
有没有和宠物有过接触？
In the physical exam, note whether the mass is midline or lateral?
在体检中，注意肿块是位于中线还是外侧？
Does it move with swallowing?
它会随着吞咽而移动吗？
A midline mass that moves with swallowing generally arises from the thyroid gland.
随着吞咽而移动的中线肿块通常来自甲状腺。
Is it tender to touch? Is it warm?
摸起来是不是有压痛？感觉肿块温度高吗？
Is the mass soft, firm or hard?
肿块是软的还是硬的？
Is it mobile or is it fixed to the underlying structures?
它是可移动的还是固定的？
Does it appear fluid filled?
里面有液体吗？
If fluid filled, does it trans illuminate this indicate a cyst.
如果里面充满了液体，是否表明这是一个囊肿。
Can the skin over the mass be pinched or is it firmly adherent to it?
肿块上的皮肤能被捏住吗？还是牢牢地附着在上面？
Is the mass pulsatile?
肿块是搏动的吗？
Pulsatile mass usually arises from a blood vessel.
搏动性肿块通常起源于血管。
If an enlarged neck node is encountered, it warrants a full examination of the head, especially mucosal surfaces from which the lymphatic drainage reaches the neck.
如果遇到颈部结节肿大，需要对头部进行全面检查，特别是淋巴引流到达颈部的粘膜表面。
Hence, the face, oral cavity, tongue, teeth, lips, saliva glands, oropharynx, nasopharynx, larynx and hypopharynx should be examined.
因此，应检查面部、口腔、舌头、牙齿、嘴唇、唾液腺、口咽、鼻咽、喉和下咽。
If direct examination of these regions is not possible, then it should be done by indirect mirrors or fibre optic devices.
如果不能对这些区域进行直接检查，则应通过间接反射镜或光纤设备进行检查。
When possible, these regions should be palpated in addition to visual inspection.
如有可能，除肉眼检查外，还应触诊这些区域。
Other lymph node groups should also be palpated, such as the axillary and inguinal lymph nodes as well as checking for spleen or liver enlargement.
其他淋巴结组也应该触诊，如腋窝和腹股沟淋巴结，检查脾脏或肝脏是否肿大。
This is because lymphoma can present with multiple enlarged lymph nodes in the neck as well as other lymph node groups, along with hepatosplenomegaly.
这是因为淋巴瘤可以表现为颈部以及其他淋巴结组中的多个淋巴结肿大，以及伴有肝脾肿大。
