肺结核病合并曲霉菌感染的诊断与外科治疗  

Diagnosis and Surgical Treatment of Pulmonary Tuberculosis Complicated by Aspergillus Infection

作　　者：蒋良双[1] 吴邦贵[1] 岳冀[2] 李曦[2] 吴桂辉[2] 刘伦旭[3] 伍伫[3] 

机构地区：[1]成都市传染病医院胸外科,成都610061 [2]成都市传染病医院结核内科,成都610061 [3]四川大学华西医院胸外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2013年第3期312-316,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨肺结核病合并曲霉菌感染患者的诊断和治疗。方法回顾性分析2008年1月至2010年12月成都市传染病医院38例肺结核病合并曲霉菌感染患者的临床资料,其中男23例,女15例;平均年龄37.8(23～59)岁。所有患者术前给予正规抗结核治疗2周以上,对术前明确合并曲霉菌感染者给予抗曲霉菌治疗3 d以上。经上述治疗后行肺叶切除术26例,右全肺切除术1例,左全肺切除术11例。术后患者均在门诊随访,开始时2周复查1次,3个月后调整为1个月1次,1年后改为6个月1次,随访期间行痰涂片查抗酸杆菌及痰培养查曲霉菌,并行胸部CT检查。结果所有患者均手术切除病灶,无围术期死亡和严重并发症发生。术后38例经病理检查证实为肺结核病合并曲霉菌感染,其基础疾病包括结核性空洞17例,结核性肺毁损12例,结核性支气管扩张症9例。所有患者均获得随访,随访时间1.5～4.5年。随访期间给予正规、足够疗程的抗结核治疗,抗真菌(伏立康唑等药物)治疗。38例患者均未再发生肺曲霉菌感染,肺结核也无复发。随访期间有1例患者再发痰中带血,经相应的治疗症状好转。结论肺结核病合并曲霉菌感染漏诊率高;手术切除病灶结合术后内科药物是治疗肺结核病合并曲霉菌感染最有效的方法。Objective To investigate diagnosis and treatment strategies of patients with pulmonary tuberculosis （TB） complicated by Aspergillus infection. Methods Clinical data of 38 patients with pulmonary TB complicated by Aspergillus infection who underwent surgical treatment from January 2008 to December 2010 in Chengdu Infectious Disease Hospital were retrospectively analyzed. There were 23 male patients and 15 female patients with their average age of 37.8 （23-59） years. Preoperatively, all the patients received regular anti-TB treatment for more than 2 weeks, and patients with definite Aspergillus infection received anti-Aspergillus therapy for more than 3 days with consultation of infectious disease physicians. After above treatment, 26 patients underwent lobectomy, 1 patient underwent right pneumonectomy, and 11 patients underwent left pneumonectomy. All the patients were followed up at the outpatient department after discharge. They were evaluated every 2 weeks in the first 3 months, every 1 month after 3 months, and every 6 months after 1 year. During follow-up, they received acid-fast bacillus smear and sputum culture to check Aspergillus, as well as CT chest scan. Results All the patients successfully received surgical resection of the pulmonary lesion without perioperative death or severe complication. Postoperative pathology examination confirmed pulmonary TB with Aspergillosis infection in all the 38 patients, whose basic diseases included TB cavity in 17 patients, TB-destroyed lung in 12 patients, and post-TB bronchiectasis in 9 patients. All the patients were followed up after discharge for 1.5-4.5years. During follow-up, they received regular anti-TB therapy for adequate duration in addition to antifungal medications such as voriconazole. None of the 38 patients had recurrence of Aspergillus infection or pulmonary TB. One patient had hemoptysis which was controlled after proper treatment during follow-up. Conclusion Missed diagnosis rate of pulmonary TB complicated by Aspergillus infection is high.

关 键 词：肺结核病 曲霉菌感染 外科手术 

分 类 号：R655.3[医药卫生—外科学]