介入治疗肺结核空洞继发曲菌球咯血的临床研究  

Clinical study of interventional therapy for pulmonary tuberculosis cavity secondary aspergilloma hemoptysis

作　　者：肖海浩[1] 张言斌[1] 汤春梅[1] 李天义[1] 陈穗[2] 张晖[3] 卢燕云[4] XIAO Haihao;ZHANG Yanbin;TANG Chunmei;LI Tianyi;CHEN Sui;ZHANG Hui;LU Yanyun(Department of Internal Medicine,Guangzhou Chest Hospital,Guangzhou 510095,China;不详)

机构地区：[1]广州市胸科医院内科,广州510095 [2]广州市胸科医院胸外科,广州510095 [3]广州市胸科医院放射介入科,广州510095 [4]广州市胸科医院内镜中心,广州510095

出　　处：《实用医学杂志》2020年第17期2381-2384,共4页The Journal of Practical Medicine

基　　金：广东省科技厅科技计划项目(编号:2016ZC0217);广东省转化医学创新平台培育建设项目B类(编号:粤卫函[2018]1254号);广州市高水平临床重点专科和培育专科建设项目(编号:穗卫函[2019]1555号)。

摘　　要：目的探讨研究一种更安全、有效治疗肺结核空洞继发曲菌球咯血的方法。方法回顾性分析2015年2月至2019年4月广州市胸科医院97例肺结核空洞继发曲菌球咯血患者的临床资料,根据治疗方式将患者分为三组:介入治疗组:支气管镜下清除术联合支气管动脉栓塞术(bronchial artery embolization,BAE)29例、外科手术组34例、内科治疗组34例。比较三组治疗后不同时间段咯血复发率及并发症等情况。结果介入组29例患者,治疗后1个月内咯血复发率为0;治疗后6个月内复发率为6.89%;治疗后12月内复发率为20.69%;均无明显并发症。外科组34例患者,术后1个月内咯血复发率为0;术后6个月内及12个月内复发率为2.94%;术后并发症的发生率为32.4%。内科组34例患者,治疗后1个月咯血复发率为44.12%,治疗后6个月内复发率为55.88%,治疗后12个月内复发率为58.82%;治疗后药物性肝损伤2例。结论BAE能有效止血,支气管镜可有效清除曲菌球,二者同时应用可达到很好的治疗效果,可作为肺结核空洞继发曲菌球咯血非外科手术治疗的一种替代疗法。Objective This study aimed to explore a safer and more effective method for the treatment ofpulmonary tuberculosis secondary aspergilloma hemoptysis.MethodsClinical data of 97 patients with pulmonarytuberculosis secondary aspergilloma hemoptysis in Guangzhou chest Hospital from February 2015 to April 2019 were retrospectively analyzed.According to the treatment method,the patients were divided into three groups:29 cases of bronchoscopic clearance combined with bronchial artery embolization(BAE,interventional treatmentgroup),34 cases of surgical operation group and 34 cases of medical treatment group.The recurrence rates andcomplications of hemoptysis in different time after treatment were compared.ResultsFor interventional group,the recurrence rate was 0 in 1 month after treatment,6.89%in 6 months after treatment and 20.69%in 12 monthsafter treatment Of 29 patients.In the surgical group,the recurrence rate was 0 in 1 month,2.94%in 6 months and12 months.The incidence of postoperative complications was 32.4%.In the internal medicine group,the recurrencerate was 44.12%in one month,55.88%in six months and 58.82%in 12 months.There were 2 cases of drug-in-duced liver damage after treatment.ConclusionBAE could effectively stop bleeding and bronchoscope effectivelyremove aspergilloma.Both of them could achieve good therapeutic effects.It could be used as an alternative non-sur-gical therapeutic method for pulmonary tuberculosis cavity secondary hemoptysis caused by aspergilloma.

关 键 词：肺结核 曲菌球 外科手术 支气管动脉栓塞术 支气管镜 

分 类 号：R521.1[医药卫生—内科学]