肺放线菌病4例临床分析

Clinical analysis of pulmonary actinomycosis:report of 4 cases

目的:探讨肺放线菌病临床表现、诊断和治疗方法。方法:总结分析4例肺放线菌病患者的临床资料。结果:4例均有咳嗽、咯脓血痰,肺部均有基础病变(分别为肺隔离症、支气管扩张症、肺囊肿、支气管异物),均曾被误诊。2例患者经可弯曲支气管镜取分泌物及肺部活组织检查(活检)阳性确诊,另2例经术后病理活检确诊。4例患者全部予处理基础病变(肺叶切除和异物摘除),其中1例患者在术前予大剂量青霉素治疗后肺放线菌病痊愈,4例患者均在术后予4～9d的抗生素治疗,随访半年至1年均未复发。结论:肺放线菌病的临床表现无特异性,容易误诊。肺部有基础病变且反复咳嗽、咯血痰而治疗效果不佳,应注意放线菌感染的可能。经可弯曲支气管镜等方法获取深部分泌物和(或)组织行病原学培养、病变组织病理学检查是主要的确诊方法。治疗上应选用青霉素等抗生素,同时应重视基础病变的处理。

Objective ： To study the clinical features, diagnosis and treatment of pulmonary actinomycosis （PA）. Methods ： The clinical data of 4 cases of PA was retrospectively studied. Results ： Four patients presented with cough and bloody sputum. All of them had underlying conditions as pulmonary sequestration, bronchiectasis, lung cyst and bronchial foreign body aspiration respectively, and all of them had been misdiagnosed. Of these patients, 2 cases were confirmed by microbiological study of lower respiratory tract secretions and lung tissues biopsy with flexible bronchoscopy. The other two cases were diagnosed following surgical resection. The underlying conditions of the 4 patients were treated by surgical resection or extraction of aspirated foreign body. PA in one patient was cured by largedose penicillin before operation. Following surgery, post-operation antibiotics for 4 -9 days was administered. No evidence of relapse was found during follow-up （ ranging between 6 months to 1 year）. Conclusion： PA has no specific clinical manifestations and is easily misdiagnosed. PA should be suspected in patients with underlying pulmonary disorders, presenting with chronic cough and bloody sputum, and unresponsive to conventional therapy. Flexible bronchoscopy enables culture of airway secretions and biopsy of lung tissues, whereas histological examination is more valuable for establishment of diagnosis. Antibiotics such as penicillin are recommended, with emphasis on management of underlying conditions.