肺结核球手术指征的探讨

A discussion on surgical indication to the lung tuberculoma

目的 讨论肺结核球误诊原因 ,提出手术指征及手术方式。方法 报告及分析 10 8例肺结核球病例资料 ,结合文献进行讨论。结果 肺结核球 10 8例 ,占同期手术总数 2 .2 %。术前误诊 37例 ,其中误诊为肺癌 30例 (病灶 <3cm者 2 2例 ) ,良性肿瘤 6例 ,曲菌球 1例。X线胸片表现不典型 4 0例 (病灶边缘有毛刺、分叶状、伴有肺门及纵隔淋巴结肿大等 )。病灶发生在肺上叶 85例 (78.7% ) ,有结核中毒症状者 5 8例 (5 3.8% )。 30例因抗结核治疗效果不佳而手术。结论 在肺部孤立病灶的诊断中应考虑结核球的可能 ,应结合临床全面分析 ,尽可能找出组织病理学依据 ,使部分结核球病人避免手术治疗。结合文献资料提出肺结核球的手术指征及手术方式。

Objective To discuss the causes of misdiagnosis of lung tuberculoma and the indication and pattern of operation.Methods To analyze 108 cases diagnosed as tuberculoma operated and literature reviewed.Results 108 cases were diagnosed as tuberculoma (2.2% of total operated cases in the same period),37 misdiagnosed with 30 cases diagnosed as lung cancer (22 cases with their lesion ≤3cm in diameter),6 benign tumour,1 aspergilloma.40 cases with atypical shadow and with enlarged hilar and mideasternal lymphnodes in the chest film.85 cases (78.7%) lesions located in upper lung field.58 cases (53.8%) had symptoms as tuberculosis.30 cases were operated due to no effective results by antiTB treatment.Conclusion Based on these results,the possibility and the existence of tuberculoma should be considered in single isolated lung lesion and it is better to have a lung biopsy for pathological examination if possible.The indication and pattern of operation in lung tuberculoma were reviewed.