肺毛霉病三例临床分析  

Retrospective analysis of three cases of pulmonary mucormycosis

作　　者：牟向东[1] 王广发[1] 刁小莉[2] 章巍[1] 李海潮[1] 李桂莲[1] 阙呈立[1] 何冰[1] 

机构地区：[1]北京大学第一医院呼吸内科,100034 [2]北京世纪坛医院病理科

出　　处：《中华结核和呼吸杂志》2007年第11期835-838,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨肺毛霉病的临床表现、诊断和治疗方法。方法报道2006年我院收治的、经纤维支气管镜检查和组织病理确诊且具有完整资料的3例肺毛霉感染病例并结合国内外文献进行复习。结果 3例均为农民,女2例,男1例,年龄42～48岁。例1和例2为糖尿病酮症酸中毒患者,例1在确诊次日因大咯血死亡;例2应用大剂量两性霉素 B(总剂量2 g)治愈;例3为肺鳞癌右上叶切除术后伴支气管狭窄,通过应用大剂量两性霉素 B(总剂量1.5 g)和支气管镜介入治疗成功治愈;例2和例3随诊0.5～1年均无复发。结论肺毛霉病患者痰培养阳性率极低,病死率很高。对临床可疑病例应及时行纤维支气管镜检查,并经组织病理学确诊;治疗的关键在于早期诊断、控制基础病、应用大剂量的两性霉素 B 和及时的外科手术。Objective To describe the clinical characteristics of pulmonary mucormycosis and to evaluate the approaches to its diagnosis and treatment. Methods Three cases of pulmonary mucormycosis were successfully diagnosed by histopathologic examination of infected tissues obtained by fiberoptic bronchoscopy in this hospital. The clinical features of the cases were analyzed and the literature reviewed. Results Three patients were all farmers and two of them had had diabetic ketoacidosis. The first patient died from massive hemoptysis one day after the diagnosis was confirmed. The second patient was cured by large doses of intravenous amphotericin B （total dosage 2 g）. The third patient presented with right middle bronchial stenosis after right upper lobectomy because of squamous carcinoma, and was cured by amphotericin B （1.5 g） combined with interventional therapy under fiberoptic bronchoscopy. The two patients were followed for 0. 5-1 year without relapse. Conclusious The mortality of pulmonary mucormycosis is high. Fiberoptic bronchoscopy is a useful diagnostic method for histopathologic examination. Successful treatment of pulmonary mucormycosis includes early diagnosis, control of underlying diseases and surgical intervention of isolated lesions combined with large dosage of amphotericin B.

关 键 词：毛霉菌病 支气管镜检查 病理学 两性霉素B 外科手术 

分 类 号：R519[医药卫生—内科学]