摘要
目的:探讨胸膜结核瘤(pleural tuberculoma,PTM)的临床特点,提高诊疗水平。方法:回顾性分析20例PTM的临床资料,并复习相关文献。结果:20例均有明确的结核性胸膜炎病史,其中8例合并继发性肺结核;PTM均出现于结核性胸膜炎之后,其中7例<2个月出现PTM,8例2~4个月出现PTM,4例4~6个月出现PTM,1例10个月出现PTM;无临床症状6例,表现为咳嗽、咳痰12例,胸痛2例。所有患者均行胸部彩色多普勒超声(彩超)、CT检查,18例行经皮肺穿刺活组织病理检查(活检),均符合PTM诊断,其中4例继续原方案治疗,16例在原治疗方案基础上加用氨基糖苷类或喹诺酮类药物,并给予B超引导下病灶局部药物注射治疗,所有患者的PTM均明显缩小。结论:PTM与结核性胸膜炎及肺结核密切相关,胸部彩超和CT检查可以协助诊断,经皮肺穿刺活检是诊断PTM的最佳方法,且在全身治疗基础上行B超引导下病灶局部药物注射治疗的患者预后均良好。
Objective To investigate clinical characteristics of pleural tuberculoma (PTM) in order to improve the diagnosis and treatment. Methods The clinical data of 20 patients with PTM were retrospectively analyzed and the related literature was reviewed. Results Twenty patients with PTM had a clear history of tuberculous pleurisy, including 8 cases with secondary pulmonary tuberculosis. They were found to have PTM after the detection of tuberculous pleurisy, of whom 7 cases were found less than 2 months, 8 cases were found in 2-4 months, 4 cases were found in 4-6 months,and 1 case was found in 10 months. Of the 20 patients, 6 cases had no clinical symptoms, 12 cases had cough and expectoration, and 2 cases had chest pain. All patients underwent chest color Doppler ultrasound (CDUS) and CT examination, and 18 patients underwent percutaneous lung biopsy (biopsy), the results of which accorded with the diagnosis of PTM. Among them, 4 cases were treated with the original regimen, 16 cases were treated with aminoglycosides or quinolones on the basis of the original regimen and B-ultrasound-guided local drug injection. The PTM lesions of all patients were significantly reduced. Conclusion PTM was closely related to tuberculous pleurisy and tuberculosis, which can be diagnosed with the assistance of chest color-ultrasound and CT. The percutaneous lung biopsy is the optimal diagnostic method for PTM. In addition, the prognosis of PTM was favorable by the treatment with B-ultrasound-guided local drug injection on the basis of general treatment.
作者
曹仕鹏
张婷
邱淑梗
CAO Shi-peng;ZHANG Ting;QIU Shu-geng(Pulmonary Clinic, Changsha Central Hospital, Changsha 410004, China)
出处
《临床误诊误治》
2019年第6期104-107,共4页
Clinical Misdiagnosis & Mistherapy
基金
国家“十二五”传染病科技重大专项(2013ZX10005004)
关键词
结核瘤
胸膜
治疗
胸膜炎
结核
结核
肺
Tuberculoma, pleural
Therapy
Pleurisy, tuberculous
Tuberculosis, pulmonary
