无免疫功能缺陷者肺曲霉感染15例临床分析

Diagnosis and treatment of pulmonary aspergillosis in patients without immunodeficiency： report of 15 cases

目的探讨无免疫功能缺陷患者肺曲霉感染的诊断及治疗。方法回顾性分析1997年1月至2006年12月在北京军区总医院胸外科住院的15例肺曲霉感染患者的病历资料。结果15例患者中男12例，女3例，年龄43—62岁，平均46．8岁。12例有肺部病变；2例肺内肿块影，CT显示有晕征；1例左主支气管腔内可见曲霉。15例均无免疫功能缺陷。肺癌空洞伴曲菌球的术前、术后诊断符合率为100％。术前经细菌学诊断者仅3例，诊断为肺癌2例。手术治疗13例，其中12例恢复良好，无并发症；1例胸膜残腔感染经开窗引流和抗曲霉治疗，感染未能控制。1例仅行抗肿瘤治疗，1例猝死。结论CT表现的晕征及组织学检查对疑有肺曲霉感染者的诊断有重要意义。基础性肺病变伴曲菌球和肿块表现的肺曲霉感染应积极手术治疗。

Objective To study the diagnosis and treatment of pulmonary aspergillosis in patients without immunodeficiency. Method Pulmonary aspergillosis in 15 patients without immunodeflciency was reviewed. Results Twelve of the patients had underlying lung diseases （ lung cancer） , 2 showed masses in the lung by radiography and CT halo, and 1 had aspergilloma within the left main bronchus. The diagnosis of intra-cavitary aspergilloma had been made in all the patients with lung cancer before surgery. Only 3 cases were confirmed by fungal examination before surgery. Thirteen patients received surgical removal of the lesions, and the post-operative recovery was uneventful. Antifungal therapy and open drainage were administered in 1 patient with pleural residual cavity infection, but the treatment failed. Anti-cancer therapy alone was given in 1 patient. Sudden death occurred in another patient. Conclusion In suspected cases of aspergillosis, CT halo sign, histology examination are helpful for the diagnosis. Aspergilloma complicated with underlying lung diseases and mass lesions can be cured by surgery.