摘要
目的:探讨肺放线菌病的临床特点,提高临床医师对肺放线菌病的诊治水平,减少误诊和漏诊。方法:回顾性分析我科收治的2例肺放线菌病的临床资料,同时结合近20年来国内66例肺放线菌病的相关文献进行分析。结果:此病以中年男性多见,男:女约为2.1:1;以36~65岁多见。病程以1年最常见。68例患者均有慢性咳嗽、咳痰等呼吸道症状。病变多局限于单叶肺叶,较少同时累及双肺。早期影像学无特殊表现,易误诊为肺结核、肺癌等呼吸道常见疾病。可通过电子气管镜检查、肺活检或细菌培养明确诊断。大剂量青霉素冲击治疗为目前首选方案。此2例患者中1例经治疗后仍不好转,于电子支气管镜下发现左下支气管内有一异物(鱼骨头),给予钳出。66例患者中88%通过抗生素治疗后好转。结论:对于无明显宿主因素的人群中,尤其是有肺放线菌病感染高危因素的患者,若经过反复治疗,仍然出现"久治不愈的肺炎症状"时,应考虑其是否存在肺放线菌病的可能性。肺放线菌病为一种良性病变,早诊断,早治疗,预后良好。
Objective：To investigate the clinical characteristics of pulmonary actinomycosis,and to improve the diagnosis and treatment of pulmonary actinomycosis and reduce misdiagnosis and missed diagnosis. Methods： The clinical data of 2 cases of pulmonary actinomycosis were analyzed retrospectively. At the same time, the literature review was carried out in 66 cases of pulmonary actinomycosis over 20 years. Results：This disease was common on middle-aged men,the male to female ratio was about 2.1：1. Age of onset was between 36 and 65 years old. The course of the disease was the most common in 1 year. All 68 patients had chronic cough, sputum and other respiratory symptoms. Lesions were mostly confined to single lobes, less involving in both lungs. Early imaging had no special performance. It could be easily misdiagnosed as tuberculosis, lung cancer and other common respiratory diseases, but could be diagnosed by electronic bronchoscopy examination, lung biopsy or bacterial culture. High-dose penicillin pulse therapy was the current preferred program. One of the two patients was not improving after treatment,and had a foreign body（fish bones）in the left lower bronchus under the electronic bronchoscopy, then it was clamped out. Of the 66 patients, 88% were cured by antibiotic treatment. Conclusions：For patients with no obvious host factor, especially those with risk factors for pulmonary actinomycosis, if there is still a ＂chronic symptoms of pneumonia＂ after repeated treatment, it shall consider whether there is pulmonary actinomycosis. Pulmonary actinomycosis is a benign lesion, and the prognosis is good with early diagnosis and treatment.
作者
陈婷婷
王莹
王瑾瑜
高梦茹
臧蕾蕾
CHEN Tingting WANG Ying WANG Jinyu GAO Mengru ZANG Leilei(Department of Respiratory Disease, Yijishan Hospital, Wannan Medical College, Wuhu 241001, China)
出处
《沈阳医学院学报》
2017年第5期407-411,共5页
Journal of Shenyang Medical College
关键词
肺放线菌病
电子支气管镜
硫磺颗粒
异物
诊断
治疗
pulmonary actinomycosis
electronic bronchoscopy
sulfur particles
foreign body
diagnosis
treatment
