原发性肺隐球菌病的临床特点及外科治疗  

Clinical features and surgical treatment of patients with primary pulmonary cryptococcosis

作　　者：汪涛[1] 梁乃超 孙玉鹗[1] 

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《临床肺科杂志》2014年第4期586-589,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的 探讨原发性肺隐球菌病的临床特点与手术治疗.方法 回顾性分析1996-2013年解放军总医院胸外科收治的27例原发性肺隐球菌病患者的临床资料与随访结果结果 48%（13/27）的患者有全身或呼吸道症状.全部患者胸片及胸部CT 误诊为肺癌、肺炎或结核.7例行FDG-PET检查,均表现为高代谢病灶.全部患者抗炎与抗痨治疗后病变无变化.3例穿刺确诊患者抗真菌治疗无法治愈.所有患者病变均手术切除.病灶切除术后16例未行抗真菌治疗,其中1例发生隐球菌性胸膜炎,经过抗真菌治疗后痊愈.全部病例随访无复发.结论原发性肺部隐球菌病的临床症状、化验检查、影像学表现均无特异性,容易误诊为肺癌或肺结核等疾病.除非病理确诊,均应手术切除,术式以局部切除为宜.Objective To investigate the clinical features and surgical treatment of patients with primary pulmonary cryptococcosis. Methods From 1996 to 2013, the clinical data of 27 patients with primary pulmonary cryptococcosis were retrospectively reviewed. Results 48% of the patients were symptomatic. All 27 cases were misdiagnosed as lung cancer or inflammatory or TB by X-ray and CT. 7 patients were given FDG-PET, which all showed high metabolic lesions. All 27 patients received antibiotic and anti-tuberculosis therapy but had no progress. Only 3 cases diagnosed as primary pulmonary cryptococcosis by needle aspiration biopsy, but antifungal therapy couldn＇t cure them. All patients received thoracotomy and their pulmonary cryptococcosis was resected. 16 patients refused antifungal therapy postoperatively but 1 of them suffered fungal infection in thoracic cavity and cured with antifungal therapy. No recurrence was found in any one of the 27 cases. Conclusion Primary pulmonary cryptococcosis is non-specific and can be confused with lung cancer, TB, etc. The pulmonary abnormalities should be resected unless the diagnosis is established.

关 键 词：肺隐球菌病 诊断 手术 

分 类 号：R519[医药卫生—内科学]