儿童胸膜结核瘤临床特征及疗效分析  

Clinical features and curative effect analysis of pleural tuberculoma in children

作　　者：袁叶玲 张锋 王团美 YUAN Yeling;ZHANG Feng;WANG Tuanmei(Department of Pediatric,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha 410000,Hunan,China;Hunan University of Chinese Medicine,Changsha 410000,Hunan,China;Changsha Hospital for Maternal and Child Health Care,Changsha 410000,Hunan,China)

机构地区：[1]南华大学衡阳医学院附属长沙中心医院儿科,湖南长沙410000 [2]湖南中医药大学,湖南长沙410000 [3]长沙市妇幼保健院,湖南长沙410000

出　　处：《临床儿科杂志》2022年第4期274-278,共5页Journal of Clinical Pediatrics

摘　　要：目的探讨儿童胸膜结核瘤(PTM)的临床、影像学特征与疗效,提高对该疾病的认识。方法回顾性分析36例PTM患儿的临床资料。结果36例患儿中男24例、女12例;农村26例、城市10例;中位年龄10.0(7.3~13.8)岁,0~5岁4例,~10岁11例,~14岁12例,>14岁9例。均有明确结核性胸膜炎病史。胸部CT扫描均提示PTM典型表现,单发病灶30例,多发病灶6例;病变位于右侧22例,左侧12例,双侧2例。均以异烟肼+利福平+吡嗪酰胺为核心抗结核方案,其中在抗结核治疗<3月出现PTM者24例,~6月出现9例,>6月出现3例。诊断为PTM后,25例维持原方案治疗,4例联用利奈唑胺、3例联用乙胺丁醇,手术治疗4例。34例治愈,2例处于治疗中。结论儿童PTM多发生在大龄男童结核性胸膜炎抗结核治疗3月内,胸部CT检查有利于发现PTM,大部分患儿经内科治疗可痊愈。Objective To investigate the clinical imaging features and efficacy of pleural tuberculoma(PTM)in children,and to improve the understanding of this disease.Methods The clinical date of 36 children diagnosed with PTM were retrospectively analyzed.Results Among the 36 patients(24 boys and 12 girls),26 were from rural areas and 10 were from urban areas,and the median age was 10.0(7.3-13.8)years.Four children were 0-5 years old,11 were 5-10 years old,12 were 10-14 years old,and 9 were>14 years old.All the children had a clear history of tuberculous pleurisy.Chest CT scans showed typical manifestations of PTM,including single lesions in 30 cases and multiple lesions in 6 cases.The lesions were located on the right side in 22 cases,on the left side in 12 cases,and on both sides in 2 cases.Isoniazid combined with rifampicin and pyrazinamide were used as the main anti-tuberculosis regimen.PTM was found in 24 patients less than 3 months after anti-tuberculosis treatment,9 patients between 3 and 6 months after treatment,and 3 patients after 6 months of treatment.After the diagnosis of PTM,25 children were treated with the original regimen,4 were treated with linezolid and 3 with ethambutol in combination,and 4 were treated with surgery.Finally,34 children were cured and 2 were under treatment.Conclusions Children's PTM mostly occurs in older boys with tuberculous pleurisy within 3 months of anti-tuberculosis treatment.Chest CT is helpful for diagnosis,and most of the children can be cured by medical treatment.

关 键 词：结核 胸膜结核瘤 临床特点 疗效 儿童 

分 类 号：R521.7[医药卫生—内科学]