摘要
目的探讨成人纵隔和肺部淋巴结结核破溃后的CT表现特点并对其治疗转归进行分析。方法搜集广州市胸科医院2009年1月至2017年12月收治的成人纵隔和肺部淋巴结结核并发破溃的52例患者进行回顾性分析。根据病变淋巴结破溃的位置而将其分成3组：只向气管支气管内破溃为气管支气管组39例；只向肺内破溃为肺组13例；同时向气管支气管和肺内破溃为气管支气管-肺组20例。分析各组患者的CT表现征象，总结破溃淋巴结的治疗转归情况。结果52例患者共有84个破溃淋巴结。气管支气管组共23个淋巴结，14个肿大淋巴结并相应支气管水肿增厚的黏膜、肉芽局部向支气管腔内呈结节状突出，CT增强扫描示13个淋巴结坏死区向气道内突出，1个为均匀强化表现，其余9个淋巴结相应瘘口侧的气道壁欠光滑但无结节征象。肺组共13个淋巴结，肿大淋巴结跨纵隔-肺、肺门-肺组织形成结节状或者肿块状，肺内病灶周围可见晕征或斑片状模糊影，CT增强扫描示12个淋巴结呈环形或分隔样强化，其内坏死区局部向肺组织内延伸，1个呈均匀强化。气管支气管-肺组患者共48个淋巴结，并发纵隔及肺门多区域多淋巴结明显肿大，其中11个向气道内、20个向肺组织内突出，CT增强扫描示后淋巴结内坏死区向瘘口侧突出，除了1个均匀强化，其余16个淋巴结相应瘘口侧的气道壁欠光滑但无结节征象。经抗结核药物、向气道内破溃的淋巴结同时经支气管镜钳取肉芽肿、抽吸坏死物等治疗，患者遗留瘘口处支气管狭窄33例，肺内遗留瘘口相关的纤维硬结灶18例。结论成人纵隔和肺部淋巴结结核发生破溃，以向气管支气管内、肺内破溃为主，CT平扫及增强有助于其早期诊断；破溃的纵隔和肺部淋巴结结核治疗后有一定效果，但部分患者遗留不同程度的支气管瘢痕性狭窄。
Objective To investigate the CT features and prognosis of tuberculous lymphatic ruptures in me- diastinum and lung in adults. Methods We retrospectively analyzed 52 adult patients with tuberculous lymphatic ruptures in mediastinum and lung in Guangzhou Chest Hospital from January 2009 to December 2017. According to the location of ruptures, the patients were divided into 3 groups： tracheobronchial group with lymph nodes only rup- tured to tracheobronchial airway, lung group with lymph nodes only ruptured to the lung, and tracheobronchiaHung group with lymph nodes ruptured into both tracheobronchial airways and lungs. Each group＇s CT manifestations and all lymphatic ruptures- prognosis were summarized and analyzed. Results There were 84 ruptured lymph nodes in 52 patients. Among them, 19 patients with 23 ruptured lymph nodes were in the tracheobronchial group, 14 of these 23 lymph nodes were with thickened mucous membrane and granulation of the corresponding bronchoederna made nodular protrusion in the airway cavity at the side of the rupture. In the CT enhancement, extension of the necrotic region to the airway could be seen in 13 of them, and 1 was homogeneous enhanced, and among the other 9 lymph nodes in this group, the airway wall close to the fistula was not smooth but with no nodular sign. There were 13 patients with 13 ruptured lymph nodes in the lung group, swollen lymph nodes crossed mediastinum or hilum to pulmonary tissue and formed nodules or masses, with halo sign or patchy shadows surrounding, and with necrotic region extended to the lung tissue in 12 of those lymph nodes after enhanced, and homogeneous enhance- ment was seen in the other 1. There were 20 patients with 48 lymph nodes ruptured in the tracheobronchial-lunggroup, which had multiple lymph nodes obviously enlarged in multiple regions in mediastinum and pulmonary hilum, 11 of which ruptured into airway, and 20 ruptured into lung. Under CT enhancement, these lymph nodes had the extension of the necrotic region to the side of fistulas except one homogeneous enhanced, and the airway walls corresponding to the fistula of the other 16 lymph nodes were not smooth but with no nodular sign in this group. After anti-tuberculosis treatment, and treatment under bronchoscope towards the lymph nodes ruptured into airway including taking out the granuloma with forceps, and suction of the necrosis, 33 patients had bronchostenosis at the fistula related remained, and 18 patients had some pulmonary fibrosis at the fistula related in the lung field remained after treatment. Conclusion TB tuberculous lymphatic ruptures of adults in mediastinum and lung are mostly ruptured to trachea, bronchus and lung. CT plain scan and enhancement is helpful for their early diagnosis. Some therapeutic effect could be found after tuberculosis treatment on most of the ruptured lymph nodes, but some cases will leave bronchial cicatricial stenosis behind.
作者
宋敏
方伟军
黎惠如
任会丽
张晖
冯惠勇
SONG Min;FANGWei-jun;LI Hui-ru;REN Hui-li;ZHANG Hui;FENG Hui-yong(Department of Radiology,Guangzhou Chest Hospital,Guangzhou 510095,China)
出处
《中国防痨杂志》
CAS
2018年第10期1110-1117,共8页
Chinese Journal of Antituberculosis
关键词
结核
淋巴结
纵隔
肺
体层摄影术
螺旋计算机
诊断显像
治疗结果
Tuberculosis, lymph node
Mediastinum
Lung
Tomography, spiral computed
Diag-nostic imaging
Treatment outcome
