肺结核空洞内继发曲菌球65例临床分析

Clinical Analysis of 65 Cases Pulmonary Tuberculosis Complicated by Aspergilloma

目的提高对肺结核空洞内继发肺曲菌球的诊治水平。方法对65例经纤维支气管镜(纤支镜)钳夹、外科手术病理证实的肺结核空洞内继发曲菌球的临床资料进行回顾分析,探讨其临床症状、影像学特征及治疗方法。结果继发性肺曲菌球的临床症状以咯血为最常见。61.5%患者显示较典型的X线征像,表现为空洞内低密度结节状或球形病灶,围以半环形气带或新月形气腔;不典型的X线征像则表现为不规则空洞内壁欠光滑及大片状病灶中有低密度结节状或球形阴影与周围病灶似有间断线状间隙或未见明显间隙。经纤支镜清除治疗和外科手术切除是目前治疗肺结核继发曲菌球的两种主要方法。结论经正规抗结核治疗后的肺结核病人出现咯血,胸部X线显示病灶增多时,认真分析其临床症状及X线特征对诊断继发性肺曲菌球非常重要。对纤支镜能到达的肺空洞内曲菌球可首选纤支镜治疗,对纤支镜难到达的肺曲菌球应选择外科手术切除。

Objective To improve the diagnosis and treatment of pulmonary tuberculosis complicated by aspergilloma. Methods 65 cases of patients with pulmonary tuberculosis complicated by aspergilloma that were confired by pathological section through bronchofibroscope or surgery were analyzed retrospectively. The clinical symptom, image character and treatment of the disease were also evaluated. Results Hemoptysis is a common clinical symptom in the patients with aspergilloma. Thoracic X-ray of 61.5% patients showed typical image, with low density tuberous and globular nidus in the cavity surrounded with semicircle or crescent vacuoles. Atypical X-ray image showed cavity with rough inner wall and large patch of nidus with low density tuberous or globular shadows. There were discontinuous threadlike gaps or no obvious gaps between the patches of nidus. At present, pulmonary aspergilloma is mainly treated by bronchofibroscopic or surgery removal. Conclusion It is important to analyze clinical symptom and X-ray character for the diagnosis of secondary pulmonary aspergilloma when pulmonary tuberculosis patients with hemoptysis or focus of infection. Removal of the focus of infection by bronchofibroscope should be first choice treatment for secondary pulmonary aspergilloma. Surgery might be applied when bronchofibroscope can not reach the focus of infection.