一种结核性脓胸分期新方法——CT分期  

A new method for staging tuberculous empyema-CT staging

作　　者：刘小玉 盛健 蒋钰辉 戴希勇 雷美 LIU Xiao-yu;SHENG Jian;JIANG Yu-hui;DAI Xi-yong;LEI Mei(Department of Pathology, Wuhan Pulmonary Hospital, Wuhan, Hubei 430030, Chin)

机构地区：[1]武汉市肺科医院胸外科,湖北武汉430030 [2]武汉市肺科医院病理科,湖北武汉430030

出　　处：《临床肺科杂志》2018年第6期987-989,993,共4页Journal of Clinical Pulmonary Medicine

基　　金：武汉市卫生计生科研基金资助(No WX17C23)

摘　　要：目的探讨结核性脓胸变化特点,为CT分期提供依据。方法根据CT特点将2014.11-2016.11我院收治的83例经手术治疗的结核性脓胸分为初期组(27例)、进展期组(23例)、稳定期组(33例),对各组病程、术前抗结核时间、ESR、CRP、病理等进行归纳总结。结果初期特点为:病程及抗结核时间最短,ESR、CRP等炎性指标最高,均显著高于稳定期(P<0.05),病理以纤维素及纤维素坏死改变为主,胸腔镜病灶廓清术手术100%治愈。进展期特点为:病程及抗结核时间较初期显著延长(P<0.05),ESR有所下降,但CRP下降更明显(P<0.001),病理有干酪样坏死、肉芽肿及纤维结缔组织增生、玻璃样变性等多种改变并存,纤维板剥脱术手术治愈率26.1%。稳定期特点为:病程及抗结核时间最长,ESR、CRP指标进一步下降,除新发少量钙化外(15.2%),其它病理类型与进展期相同,但稳定期干酪样坏死(39.4%)比例显著低于进展期(82.6%,P=0.003),而玻璃样变及坏死(84.8%)明显高于进展期(30.4%,P<0.001),纤维板剥脱术治愈率84.8%,显著高于进展期(P<0.001)。结论结核性脓胸CT分期的依据较充分,可为临床手术方式及时机的决策提供参考。Objective To explore the characteristics of tuberculous empyema at various stages, in order to provide the basis for CT staging. Methods 83 patients who were operated on tuberculous empyema from November 2014 to November 2016 in our hospital were divided into three groups according to CT characteristic： the initial group （27 cases）, the progress group （23 cases）, and the stable period group （33 cases）. Inductive summary method was used to characterize the data of each group from duration of disease, preoperative anti-tuberculosis time, ESR, CRP, pathology and operation. Results In the initial group, the duration of disease and preoperative anti-tuberculosis time were the shortest in the three groups （ P 〈0.05）. The inflammatory index of ESR/CRP were supreme, and higher than the stable period group （ P 〈0.05）. The cellulose and cellulose-like necrosis were mainly changes （100%）. The operation recovery rate was 100%. In the progress period group, the duration of disease and preoperative anti-tuberculosis time were significantly prolonged （ P 〈0.05）. ESR declined, but CRP declined significantly （ P 〈0.001）. Multiple pathological changes coexisted as fallows： caseoue necrosis, granulomatous inflammation, fibrous connective tissue hyperplasia, hyaline degeneration and necrosis. The operation recovery rate of stripped pleural fibreboard was 26.1%. In the stable period group, the duration of disease and preoperative anti-tuberculosis time were the longest in the three groups （ P 〈0.05）. ESR and CRP declined further. The pathological changes ware the same as the progress group but calcification existed only in the stable group （15.2%）. The stable caseous necrosis ratio （39.4%） was significantly less than the progress period （82.6%, P =0.003）, but the Hyaline degeneration and necrosis ratio （84.8%, 28/33） was significantly higher than the progress period （30.4%, P 〈0.001）. The operation recovery rate of stripped pleural fibreboard was 84.8%, bett

关 键 词：结核性脓胸 CT分期 

分 类 号：R521.7[医药卫生—内科学]