结核性胸膜炎治疗过程中合并胸膜结核瘤的临床分析

Clinical analysis on pleural tuberculoma in the process of treating tuberculous pleurisy

目的 研究结核性胸膜炎治疗过程中合并胸膜结核瘤的鉴别诊断与治疗方法.方法 选取2010年1月～2013年1月入院诊治的结核性胸膜炎并发胸膜结核瘤的患者48例,同时选择同期入院诊治的间皮瘤患者48例作为对照组,所有患者均采用X线胸部正侧位片及CT扫描进行影像学观察,分析鉴别两组患者临床表现与影像学表现;同时进行胸水化验,并总结治疗方法.结果 胸膜结核瘤女性占比62.50%,70.83%患者年龄在50岁以上,75%出现左侧胸腔积液,无长期接触石棉粉尘患者.出现发热、出汗症状的人数显著多于胸膜间皮瘤患者（P ＜ 0.05）;而咳嗽、并发气胸人数显著低于胸膜间皮瘤患者（P ＜ 0.05）.确诊后未行手术的41例患者,经治疗后,病灶吸收27例,病灶不变者7例,7例患者因病灶进一步扩大而行手术治疗.结论应用CT扫描可有效诊断胸膜结核瘤.

Objective To study the diagnosis and treatment method of pleural tuberculoma in the process of treating tuberculous pleurisy. Methods A total of 48 patients with tuberculous pleurisy complicated by pleural tuberculoma treated in our hospital from January 2010 to January 2013 were selected. And 48 patients with mesothelioma treated in our hospital during the same period were selected. All patients received radiographic examination by X-ray chest an- teroposterior and lateral film and CT scan. The clinical manifestations and radiographic manifestations of two groups were analyzed. And all patients received pleural effusion test. The treatment methods were summarized. Results The female with pleural tuberculoma accounted for 62.50%. 70.83% of patients were more than 50 years old, and there were 75% of patients with pleural effusion on the left side. There was no patient with long-term exposure to asbestos dust. There were more patients with fever and perspiration than the patients with pleural mesothelioma （P 〈 0.05）, and there were less patients with cough and complicated with pneumothorax （P 〈 0.05）. For 41 patients without receiving operation, after treatment, there were 27 cases with lesions absorption, 7 patients with lesions remaining the same, and 7 patients received operation because of lesions widening. Conclusion Applying CT scan can effectively diagnose pleural tuberculoma.