锡冶炼工尘肺病患者胸部影像学改变动态观察  

Dynamic observation on changes of chest imaging in pneumoconiosis patients in tin smelting workers

作　　者：李忠学[1] 李小萍[1] 黎乾昌 汤永中 邓明 叶绍色[1] 

机构地区：[1]广西壮族自治区职业病防治研究院,广西南宁530021

出　　处：《中国职业医学》2017年第5期576-579,共4页China Occupational Medicine

基　　金：公益性卫生行业科研专项基金(201402021)

摘　　要：目的观察锡冶炼工尘肺病患者胸部影像学改变和转归情况。方法对10例锡冶炼工尘肺病病例进行胸部X射线和电子计算机断层扫描(CT)摄影及动态观察,分析其肺部影像学特点和转归情况。结果 10例锡冶炼工尘肺病患者的临床症状轻微,未见合并肺结核,肺通气功能改变不明显。诊断时X射线高千伏胸片结果显示:两肺小阴影形态以圆形为主,多分布在双肺中上肺区;多数病例肺纹理扭曲、变形或增多、模糊,肺门影增大增粗,淋巴结点状钙化,个别状如蛋壳,未见胸膜改变和肺气肿改变;5~10年的动态观察除1例患者小阴影增多外,其余均未见明显改变。2011年胸部CT检查可见2~5 mm的结节状影;其中,7例患者小结节从两上肺叶均匀分布至中叶、两肺下叶背段,下叶基底段病变减少;病变呈弥漫分布全肺叶,且胸膜下有小结节者3例;小叶间隔不同程度增厚5例;有小叶中心型或间隔旁肺气肿4例;其中1例有肺大泡形成。10例患者2016年胸部CT检查结果与2011年比较,弥漫性肺结节增多2例,小叶间隔增厚明显3例,肺气肿有进展2例。结论锡冶炼工尘肺病患者肺部小阴影经5~10年的X射线动态观察未见明显吸收,且病变有进展。CT检查有助于对锡冶炼工尘肺病进行追踪观察。Objective To observe the changes of chest imaging and prognosis in pneumoconiosis patients in tin smelting workers. Methods Ten pneumoconiosis patients working with tin smelting were examined by chest X-ray,computed tomography（ CT） photography and dynamic observation on pulmonary imaging to analyze their characteristics and prognosis. Results There were mild clinical manifestations and no tuberculosis in these 10 cases of tin smelting pneumoconiosis patients. There was no obvious change on the pulmonary ventilation function change. The high k V X-ray chest observation results showed that the circular shadow was the primary small shadow of the two lungs,that were mostly distributed in the medium and upper lung zones of both lungs. In most cases,we found lung texture distortion,deformation or increase,blurred,hilar shadow increased thickening,lymph node calcification,individualized eggshell. There was no pleural changes and emphysema changes. There was no significant change found in 5-10 years of dynamic observation except for 1 case of increased small shadow. The chest CT examination in 2011 showed 2-5 mm nodular shadows. Among them,we found 7 cases of small nodules from the upper lobe evenly distributed to the middle of the lobe,the lower back lobe of the lungs,lower basal ganglia lesions decreased,lesions were diffuse distribution of the whole lung,and the small nodules in 3 cases. Interval lobular thickening at varying degrees were found in 5 cases,lobular central or apoptotic pulmonary emphysema were found in 4 cases,and 1 case of pulmonary bullae formation was found. The results of chest CT examination in 2016 showed 2 cases of diffuse pulmonary nodules,3 cases of thickening of lobular septum and 2 cases of pulmonary emphysema compared with the CT result in 2011. Conclusion There was no obvious lung small shadow absorption found in tin smelting pneumoconiosis patients after 5 to 10 years of X-ray dynamic observation,and progress of lesions could be seen. CT examination is helpful for follow-up observation

关 键 词：锡冶炼工 尘肺病 锡尘肺 影像学 X射线 电子计算机断层扫描 动态观察 

分 类 号：R135.2[医药卫生—劳动卫生]