目的： 探讨儿童颈部淋巴结肿大的病因，分析其临床特点以指导临床诊断与治疗。方法： 对2014年1月至2020年12月在我院因颈部淋巴结肿大行活检的481例患儿临床资料、病理结果以及预后等进行回顾性分析。结果： 淋巴结活检病例数有逐年增多趋势，学龄期较学龄前期增多尤为明显（P=0.047）。在疾病谱上慢性非特异性淋巴结炎多见学龄前期（P<0.001），而坏死性淋巴结炎多见学龄期（P<0.001），其余疾病分布无明显差异。恶性肿瘤52例（10.81%），其中淋巴瘤36例（69.23%）。肿瘤组术前超声提示异常16例（30.77%）；肿瘤组年龄、性别、淋巴结位置、有无临床症状、淋巴结大小与非肿瘤组比较差异均无统计学意义。肿瘤组炎症指标升高较非肿瘤组明显（P=0.016 9）。对慢性非特异性淋巴结炎270例（56.13%）、淋巴结反应性增生31例（6.44%）进行随访，成功222例（73.75%），复发7例（3.15%），有慢性病病史47例（21.17%）。结论： 对儿童尤其学龄期儿童颈部淋巴结肿大的关注逐年增高，而临床表现、检查缺乏特异性，对于慢性非特异性、特殊感染、免疫、代谢、肿瘤等因素引起的淋巴结肿大鉴别仍需进行病理活检。

[1] HEIDIL G,ANGELA M R.Unexplained lymphadenopathy:evaluation and differential diagnosis[J].Am Fam Physician,2016,94(11):896-903.
[2] DAVID K,JAGADEESH R,DANIEL Y.Lymphadenopathy in children:refer or reassure?[J].Arch Dis Child Educ Pract Ed,2014,99(3):101-110.
[3] ANDREW W B,DOUGLAS R S.Lymphadenopathy and malignancy[J].Am Fam Physician,2002,66(11):2103-2110.
[4] AL KADAH B,POPOV H H,SCHICK B,et al.Cervical lymphadenopathy:study of 251 patients[J].Eur Arch Otorhinolaryngol,2015,272(3):745-752.
[5] EMILY B,MUAYAD A,JOSEPH R H,et al.Kikuchi-Fujimoto disease in children:an important diagnostic consideration for cervical lymphadenitis[J].Pediatr Ann,2019,48(10):406-411.
[6] GULERIA S,GUPTA A,PILANIA R K,et al.Kikuchi-Fujimoto disease:an under recognized cause of fever with lymphadenopathy[J].Indian J Pediatr,2020,87(1):85.
[7] 李静,詹学.儿童淋巴结结核166例临床分析[J].中华临床医师杂志(电子版),2015,9(23):4348-4354.
[8] YANG J S,DU Z X.Comparison of clinical and pathological features of lymph node tuberculosis and histiocytic necrotizing lymphadenitis[J].J Infect Dev Ctries,2019,13(8):706-713.
[9] HANNAH L,GRAEME V D M,MAYAAN G,et al.Castleman's disease:an unusually young presentation resulting in delayed diagnosis of a neck mass[J].Int J PediatarOtorh,2016,86(7):90-92.
[10] NEHA S,ADITYA S,BIPASHA M.Management strategies in Rosai-Dorfman disease:to do or not to do[J].J Pediatr Hematol Oncol,2016,38(7):248-250.
[11] JOHN R G,LAURA V.Acute,subacute,and chronic cervical lymphadenitis in children[J].Semin Pediatr Surg,2006,15(2):99-106.
[12] KYEONG H R,KWANG H L,JIHWAR R,et al.Cervical lymph node imaging reporting and data system for ultrasound of cervical lymphadenopathy:a pilot study[J].AJR,2016,206(6):1286-1291.
[13] PARK J E,RYU Y J,KIM J Y,et al.Cervical lymphadenopathy in children:a diagnostic tree analysis model based on ultrasonographic and clinical findings[J].Eur Radiol,2020,30(8):4475-4485.
[14] 张文智,杨高怡,钟方明,等.颈部淋巴结结核超声造影指导下粗细针穿刺活检的对比分析[J].中国超声医学杂志,2019,35(10):884-886.
[15] 冉冬梅.颈部淋巴结结核针吸细胞学假阴性30例临床病理分析[J].中国实用医药,2014,9(20):90-91.
[16] MARIA I,VIGGO B,CHRISTOFFER H H.Evaluation of cervical lymphadenopathy in children:advantages and drawbacks of diagnostic methods[J].Dan Med J,2013,60(8):1-3.