| 摘要: |
| ［摘要］ 目的 探讨肺曲霉病的诊断与治疗。方法 回顾性分析2008-01～2010-12经肺切除术后病理证实的53例肺曲霉病（曲霉球24例，慢性坏死性肺曲霉病21例，慢性坏死性肺曲霉病合并曲霉球8例）患者的病历资料。结果 53例中有基础疾病39例，最常见为肺结核，其次为支气管扩张症，临床表现无特异性。影像学检查病变部位以上肺最常见，共37例；病灶特点以肺叶、肺段浸润阴影伴空洞最多见，共43例；新月征7例，空洞内附壁结节影或不规则块状致密影27例。所有患者均经肺切除术后病理检查确诊，50例患者未行抗真菌治疗。术后复发的5例为慢性坏死性肺曲霉病、双肺多叶病变且术后未行抗真菌治疗者。结论 慢性坏死性肺曲霉病与曲霉球临床表现无特异性，易误诊为肺结核，出现新月征有提示性诊断意义，确诊需要病理依据。曲霉球首选手术治疗，慢性坏死性肺曲霉病可予药物治疗或手术治疗，病灶切除完全、无基础病和免疫功能抑制者可不用抗真菌治疗。 |
| 关键词: 肺曲霉病 诊断 治疗 |
| DOI：10.3969/j.issn.1674-3806.2012.07.04 |
| 分类号:R 563 |
| 基金项目:广西卫生厅重点科研课题（编号：桂卫重2011067） |
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| Clinical analysis of 53 cases of pulmonary aspergillosis |
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LI Wu-ming,WEI Ming,MENG Zhi-Hao,et al.
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Department of Respiratory Medicine,Longtan Hospital of Guangxi Zhuang Autonomous Region,Liuzhou 545005,China
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| Abstract: |
| ［Abstract］ Objective To study the diagnosis and treatment of pulmonary aspergillosis.Methods The case histories of 53 patients with pulmonary aspergillosis(24 with aspergillus ball, 21with chronic and necrotizing pulmonary aspergillosis, 8 with aspergillus ball complicated with chronic and necrotizing pulmonary aspergillosis), pathologically confirmed from January, 2008 to December, 2010 after pneumectomy were retrospectively analyszed.Results There were 39 cases with underlying disease, of which the most common was tuberculosis and the second was bronchiectasis, lacking specificity of clinical manifestations. Imaging examination showed the diseased region mainly located in the upper part of lung, a total of 37 cases; The main features lesions were pulmonary lobe and segment′s infiltration with cavity, a total of 43 cases; air crescent, 7 cases; cavernous nodule with internal attachment or irregular lump opacities, 27 cases. All patients were pathologically diagnosed after pneumectomy, without antifungal treatment, 5 cases with recurrence of them were those who suffered chronic and necrotizing pulmonary aspergillosis and multiple pulmonary lobes lesion of double lungs.Conclusion Lacking specificity of clinical manifestations, it is easy to be misdiagnosed tuberculosis for aspergillus ball and chronic and necrotizing pulmonary aspergillosis. Air crescent shows its significance on predictive diagnosis, and making a definite diagnosis requires pathological foundation. The first choice of aspergillus ball can come to surgical treatment, while chronic and necrotizing pulmonary aspergillosis can turn to medication or surgical treatment. With complete lesion resection and without underlying disease, those who have immunological function repression can not need the antifungal treatment. |
| Key words: Pulmonary aspergillosis Diagnosis Treatment |
