肺毛霉病的支气管镜表现及介入治疗  

Bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis

作　　者：曾璞 牟向东 王莉洁 郭文佳 赵景全 尹洪芳 姚晶晶 武华旭 林连君[3] 刘新民[3] 马晓旭[4] 王红民[4] 赵艳丽 Zeng Pu;Mu Xiangdong;Wang Lijie;Guo Wenjia;Zhao Jingquan;Yin Hongfang;Yao Jingjing;Wu Huaxu;Lin Lianjun;Liu Xinmin;Ma Xiaoxu;Wang Hongmin;Zhao Yanli(Department of Respiratory and Critical Care Medicine,Beijing Tsinghua Changgung Hospital,Medical Center,Tsinghua University,Bejing 102218,China;Department of Pathology,Beijing Tsinghua Changgung Hospital,Medical Center,Tsinghua University,Beijing 102218,China;Department of Geriatrics,First Hospital of Peking University,Beijing 100034,China;Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Hematology,Hebei Yanda Ludaopei Hospital,Langfang 065201,China)

机构地区：[1]北京清华长庚医院呼吸与危重症医学科清华大学医学中心,北京102218 [2]北京清华长庚医院病理科清华大学医学中心,北京102218 [3]北京大学第一医院老年科,北京100034 [4]郑州大学第一附属医院呼吸内科,郑州450000 [5]河北燕达陆道培医院血液科,廊坊065201

出　　处：《中华结核和呼吸杂志》2023年第2期151-157,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家重点研发计划(2020YFC2005401);北京市属医院科研培育计划项目(PX2020041);清华大学春风基金国内科研专项(2020Z99CFY033)。

摘　　要：目的回顾性分析肺毛霉病的支气管镜表现及介入治疗。方法收集2006年5月至2022年5月行支气管镜检查及介入治疗的肺毛霉病患者的临床资料, 对其进行回顾性分析, 并结合文献复习。结果共收集行支气管镜检查及介入治疗的肺毛霉病患者临床资料共10例, 其中男性8例, 女性2例, 患者年龄21~72(44.3±15.6)岁。基础病包括糖尿病酮症酸中毒6例、白血病3例、肺癌术后1例。胸部CT显示肺部病变累及单个肺叶6例, 累及多个肺叶4例。支气管镜表现为白色黏稠状坏死物沿气道生长并阻塞气道9例, 伴气道内出血3例, 血性分泌物阻塞气道1例, 支气管肺空洞瘘2例。白色坏死物活检组织病理学显示为大量毛霉菌丝杂乱缠绕在一起, 我们将其命名为毛霉菌丝体(mucormycelium)。10例患者中, 全身药物治疗9例, 包括两性霉素B脱氧胆酸盐静脉滴注5例, 两性霉素B脂质体静脉滴注4例, 泊沙康唑口服6例, 泊沙康唑静脉滴注1例。局部药物治疗包括两性霉素B脱氧胆酸盐雾化吸入治疗8例, 支气管镜下局部灌注治疗5例。支气管镜介入治疗包括应用冷冻探头冻取病灶8例, 活检钳钳除病灶7例, 圈套器圈套治疗2例, 异物钳钳取病灶2例。10例患者均临床治愈, 死亡0例。结论肺毛霉病常见于免疫抑制宿主, 支气管镜常表现为毛霉菌丝体阻塞气道;全身和局部药物治疗联合支气管镜介入治疗可取得较好的临床疗效。Objective To analyze the bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis.Methods Clinical data of patients with pulmonary mucormycosis undergoing bronchoscopy and interventional therapy in 4 tertiary general hospitals in China from May 2006 to May 2022 were retrospectively analyzed and the literature on the subject were reviewed.Results The data of 10 patients with pathologically diagnosed pulmonary mucormycosis undergoing bronchoscopy and interventional therapy were collected,including 8 males and 2 females.The patients′age ranged from 21 to 72(44±15)years.The underlying diseases included 6 cases of diabetes ketoacidosis,3 cases of leukemia,1 case after operation of lung cancer.Bronchoscopy showed that white viscous necrotic matters grew along the airway and blocked the airway in 9 cases,accompanied by airway bleeding in 3 cases,bloody secretion blocked the airway in 1 case,and bronchopulmonary cavity fistula in 2 cases.The biopsy histopathology of white necrotic matters showed that many mucor filaments were tangled together which were named mucormycelium.Among the 10 patients,9 were treated with systemic drugs,including intravenous application of amphotericin B deoxycholate in 5 cases,intravenous application of amphotericin B liposome in 4 cases,oral posaconazole in 6 cases and intravenous injection in 1 case.Local drug therapy included aerosol inhalation of amphotericin B deoxycholate in 8 cases and local perfusion under bronchoscope in 5 cases.Bronchoscopic interventional therapy was used to remove mucormycelium in the bronchus,including cryotherapy in 8 cases,biopsy forceps in 7 cases,snare treatment in 2 cases and foreign body forceps in 2 cases.All 10 patients were clinical cured and with no death.Conclusions Pulmonary mucormycosis is more common in immunocompromised hosts.Bronchoscopy often showed mucormycelium blocking the airway.Systemic and local drug therapy combined with bronchoscopic interventional therapy can achieve good clinical efficacy.

关 键 词：毛霉菌病 支气管镜 毛霉菌丝体 介入治疗 

分 类 号：R519[医药卫生—内科学]