78例肺结核合并喉结核临床分析  

Clinical analysis of 78 cases of pulmonary tuberculosis complicated with laryngeal tuberculosis

作　　者：程超 尤青海[2] 吕莉萍 CHENG Chao;YOU Qing-hai;Lü Li-ping(Department of Lung Interventional Therapy,Anhui Chest Hospital,Hefei,Anhui 230022,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽省胸科医院介入肺脏病科,安徽合肥230022 [2]安徽医科大学第一附属医院呼吸与危重症医学科,安徽合肥230022

出　　处：《临床肺科杂志》2021年第2期280-283,共4页Journal of Clinical Pulmonary Medicine

基　　金：广东艾滋病、病毒性肝炎和结核病社区综合防治研究项目(No.2018ZX10715004);宝安区科技创新局医疗卫生基础研究项目(No.2018JD047)。

摘　　要：目的探讨肺结核合并喉结核的临床特征,提高肺结核合并喉结核的诊疗水平。方法回顾性分析2016年4月至2019年8月入住我院的78例肺结核合并喉结核患者的临床资料,包括:电子支气管镜、胸部CT、活检病理、抗酸染色涂片、结核菌培养、结核菌分子检测等结果,同时了解是否合并其他部位结核、诊疗经过是否存在误诊,并对抗结核方案及疗效随访。结果肺结核合并喉结核患者除表现为咳痰、胸闷、低热盗汗及周身乏力等症状外,常具有典型的喉部症状,主要表现为声音嘶哑(47例,60.26%)、咽喉部疼痛(24例,30.77%)和咽部异物感(5例,6.41%)。镜下喉结核病灶局限于一个部位者17例(21.79%),两个及两个部位以上累及者61例(78.21%),累及声带者48例(61.54%)。喉结核主要以肉芽增殖型(14例,17.95%)、炎症浸润型(15例,19.23%)、溃疡坏死型(10例,12.82%)为主,混合型多见(39例,50.00%)。肺结核合并喉结核患者常同时合并其他部位结核,以气管支气管结核、颈淋巴结结核及肠结核多见。因缺乏有效认知,肺结核合并喉结核易出现临床误诊,以误诊咽喉炎及声带息肉多见。入组患者经正规系统性抗结核治疗后,喉部症状消失,预后良好,平均疗程14.41±2.99月,较单纯肺结核组疗程延长,差异有统计学意义。结论肺结核合并喉结核常具有声嘶、咽痛及咽喉部异物感等典型喉部症状。喉部病灶分布范围广,以混合型多见。因缺乏有效认知,常被临床误诊。一经确诊,经正规抗结核治疗可获得良好疗效。Objective To explore the clinical features of pulmonary tuberculosis complicated with laryngeal tuberculosis and improve the diagnosis and treatment level of pulmonary tuberculosis complicated with laryngeal tuberculosis.Methods The clinical data of 78 patients with tuberculosis complicated with laryngeal tuberculosis admitted to our hospital from April 2016 to August 2019 were retrospectively analyzed,including:electronic bronchoscopy,chest CT、biopsy pathology,acid-fast staining smear,tuberculosis culture,molecular detection of tuberculosis bacteria and so on.At the same time,whether there was tuberculosis in other parts,whether there was misdiagnosis,and the anti-tuberculosis program and follow-up of curative effect were analyzed.Results In addition to expectoration,chest tightness,low fever,night sweating and fatigue,pulmonary tuberculosis patients often had typical laryngeal symptoms,mainly characterized by hoarseness(47 cases,60.26%),sore throat(24 cases,30.77%)and foreign body sensation in pharynx(5 cases,6.41%).Microscopically,17 cases(21.79%)were confined to one site,61 cases(78.21%)were involved in two or more sites,and 48 cases(61.54%)were involved in vocal cords.The main types of laryngeal tuberculosis were granulation proliferation(14 cases,17.95%),inflammatory infiltration(15 cases,19.23%),ulcer necrosis(10 cases,12.82%),mixed type(39 cases,50.00%).Pulmonary tuberculosis complicated with laryngeal tuberculosis patients often had other parts of tuberculosis,tracheobronchial tuberculosis,cervical lymph node tuberculosis and intestinal tuberculosis.Due to lack of effective cognition,pulmonary tuberculosis complicated with laryngeal tuberculosis was prone to clinical misdiagnosis,mainly misdiagnosed as pharyngitis and vocal cord polyp.After regular systemic anti-tuberculosis treatment,the laryngeal symptoms disappeared and the prognosis was good.The average course of treatment was 14.41±2.99 months,which was longer than that of simple pulmonary tuberculosis group.The difference was statistically signi

关 键 词：肺结核 喉结核 诊断 治疗 

分 类 号：R521[医药卫生—内科学] R529.8[医药卫生—临床医学]