42例咯血肺结核患者手术病理与转归的随访研究

A follow-up study on surgical pathology and outcome of 42 patients with pulmonary tuberculosis complicated with hemoptysis

目的通过对42例伴咯血的肺结核手术患者术后病理与预后相关性的随访研究,分析肺结核合并咯血,尤其是反复咯血的原因,探讨诊断及治疗思路。方法回顾性分析西安市胸科医院自2013年1月至2016年12月因咯血行肺叶切除42例患者的临床资料及术后病理结果,探讨咯血尤其是反复咯血的原因及其随访治疗后果。结果 42例患者经手术病理确诊及对应治疗后,40例获得良性转归,无死亡及咯血复发;2例不良转归咯血复发。42例患者中,5例咯血患者经规律抗结核1-6月后行手术治疗,病理结果证实肺结核;25例患者经9-12月规律抗结核停药后再次出现咯血行手术治疗,病理结果证实肺结核7例、支气管扩张7例、曲菌感染6例、肺结核合并曲菌感染3例,肺大疱1例、肺脓肿1例;12例患者因反复咯血病史2年-20年不等行手术治疗,术后病理证实肺结核2例,支气管扩张4例、曲菌感染4例、肺腺癌1例、瘤样增生1例。结论初治肺结核咯血应坚持规律抗结核治疗;规律抗结核治疗停药后再次出现咯血患者中除外肺结核复发,应考虑支气管扩张、曲菌感染可能,继续抗结核治疗应慎重选择;肺结核咯血病史较长,反复出现咯血,在考虑肺结核、支气管扩张、曲菌感染的基础上,应考虑肺部肿瘤可能。

Objective To discuss the causes of hemoptysis,especially repeated hemoptysis and the followup treatment through retrospective analysis 42 TB patients complicated with hemoptysis. Methods The clinical data and pathological Results of 42 TB patients complicated with hemoptysis received pulmonary lobectomy from January2013 to December 2016 were retrospectively analyzed,and the causes of repeated hemoptysis were followed-up and analyzed. Results 42 patients were diagnosed by surgery and the corresponding treatment,and 40 patients had benign outcome. There was no death or hemoptysis recurrence,and 2 patients had poor prognosis and hemoptysis recurrence after operation. 5 patients were given surgery after 1-6 months regular anti-tuberculosis treatment and then were pathologically confirmed with TB. 25 patients had hemoptysis again and then were given surgery after 9-12 months anti-tuberculosis treatment,and the pathological results included 7 cases of pulmonary tuberculosis,7 cases of bronchiectasis,6 cases of aspergillosis infection,3 cases of tuberculosis with aspergillosis infection,1 case of bullae of lung,and 1 case of lung abscess. 12 patients had a history of recurrent hemoptysis ranging from 2 years to 20 years with surgical treatment The pathological results included 2 cases of pulmonary tuberculosis,4 cases of bronchiectasis,4cases of aspergillosis,1 case of lung adenocarcinoma and 1 case of tumor-like hyperplasia. Conclusion Initial-treated tuberculosis hemoptysis patients should adhere to the principle of anti-tuberculosis treatment. Except tuberculosis,bronchodilatation and aspergillosis should be considered while those patients have hemoptysis after regular anti-tuberculosis treatment withdrawal,and anti-TB treatment should be carefully chosen again. For those with long history of tuberculosis hemoptysis and repeated hemoptysis patients,except tuberculosis,bronchial expansion,or parasitic infection,lung cancer should be considered.