肺曲菌球的诊断与外科治疗-肿瘤学专业论文.docxVIP

汕头大学医学院 2005 汕头大学医学院 2005 级硕士研究生学位论文 彭均伟 PAGE PAGE III Abstract Objective To discuss the diagnosis and surgical treatment of pulmonary aspergilloma. Methods The clinical data of 7 patients with pulmonary aspergilloma in our hospital were retrospectively analyzed. Results Of 7 cases，6 cases were male and 1 case female. Their ages ranged from 25 years to 52 years, with average 35 years old.The disease -course of those cases ranged from 3 months to 5 years, with average 2.3 years.The main clinical symptoms included cough 、 expectoration 、 hemoptysis、 fever、 chest pain and so on.The hemoptysis was main cause of patients receiving treatment. Typical imaging of pulmonary aspergilloma was showed in CT inspection of 6 cases. All patients were subjected to surgical treatment.Of them ,2 cases were treated by wedge resection of lung,5 cases by pulmonary lobectomy. The complication of surgery treatment included pulmonary collapse、pleural effussion、lung infection、 pyothorax、wound infection.All patients were cured. Conclusion The clinical manifestation of the cases with pulmonary aspergilloma are of few characteristic value in diagnosis of pulmonary aspergilloma . Diagnosis of pulmonary aspergilloma dependent mainly on imaging inspection、mycology inspection、bronchofibroscope and pathology inspection.The typical imaging is of significant value in clinical diagnosis. The wedge resection of lung or pulmonary lobectomy is main treatment method. Key words pulmonary aspergilloma， diagnosis，surgical treatment. 前 言 肺曲霉菌病(pulmonary aspergillosis)是临床较少见的一种肺部真菌感 染。曲霉菌在自然界广泛分布,主要寄生于人类上呼吸道, 由于正常人的免疫防 御功能的存在，通常少量曲菌不引起疾病,当人体免疫力下降或大量病原体入侵 人体时,可致感染、发病。近年来由于广谱抗生素，细胞毒药物，免疫抑制剂及 肾上腺皮质激素的广泛应用，器官移植，AIDS 增加，以及肺结核病发病率的上 升使肺曲霉菌病有逐年增多趋势。临床常见为腐生烟曲霉菌感染，目前将本病分 成 三 型 ： 变 态 反 应 性 肺 曲 菌 病 （ allergic bronchopulmonary aspergillosis,ABPA ） 、 侵 入 性 肺 曲 菌 病 (invasive pulmonary aspergillosis,IPA )和肺曲菌球[1，2]。肺曲霉菌感染形成肺部孤立或多发的球形 病灶,影像学典型表现为球形病灶与腔壁间有新月样透亮区“新月征”,称之为 肺曲菌球，在肺曲霉菌感染中最为多见。 肺曲菌球的临床表现多种多样，以咳嗽咳痰、咯血、发热、胸痛、胸闷等