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初治空洞肺结核54例临床分析 总被引:2,自引:0,他引:2
目的 探讨初治空洞性肺结核的临床特点及短程化疗效果。方法 回顾性分析54例初治空洞性肺结核的临床资料。结果 54例患者中发热49例,咳嗽50例,乏力、盗汗32例,白细胞总数升高40例,痰涂片结核菌阳性17例。X线胸片表现为单发、薄壁、干酪性空洞46例,病变累及3个以上肺野40例。完成6个月化疗后,病程10~30d者空洞治疗有效率77.8%(28/36),病程30~60d者空洞治疗有效率44.4%(8/18)。结论 初治空洞肺结核多有典型的结核中毒症状,X线胸片以单发、薄壁、干酪性空洞为主,病变累及多个肺野,早期治疗有利于空洞吸收。 相似文献
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目的 探讨肺曲菌球与肺结核的关系及其诊断和治疗;方法 对13年经外科手术治疗的47例肺结核合并曲菌球病人进行回顾性分析;结果 男性31例,占66.0%,病程>5年27例。咯血症状突出,41例,占87.2%。47例肺结核合并曲菌球中,术前明确诊断32例,占68.1%,漏误诊率31.8%。45例治愈,占95.7%,死亡2例,占4.2%。术后并发症10例,分别为胸腔感染、支气管胸膜瘘、肺炎、肺不张、支气管哮喘、呼吸衰竭和失血性休克。结论 肺曲菌球病见于肺结核空洞患者,在长期规律抗结核治疗后仍反复咯血,漏诊率较高,手术治疗为首选,效果较好。 相似文献
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目的 掌握暂住人口结核病控制项目管理和治疗的效果,方法 对在东莞市确诊并登记的暂住人口肺结核病人提供与常住人口相同的免费诊疗政策和实施DOTS管理。结果 对2001年8月—2004年6月登记的1171例在东莞市居住满6个月以上暂住人口的初治涂阳和有空洞或血行播散性涂阴肺结核病人进行管理和治疗。初治涂阳治愈率98.5%,达到常住人口治疗效果。结论 对暂住人口肺结核病人实施DOTS策略是可行和有效的。 相似文献
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目的 分析合并糖尿病的肺结核胸部影像学征像,以期为临床综合诊断提供依据。方法 回顾性分析45例合并糖尿病肺结核患者的胸部影像学与相关临床资料。结果 大片状致密性阴影占68.9%,多发小空洞性阴影占68.9%,散在片状及小斑片阴影占26.7%,结节、肿块状阴影占4.4%。结论 熟悉这些不同形态的影像学特点,对合并糖尿病的肺结核在诊断及病情分析中有重要参考价值。 相似文献
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目的 探讨肺结核患者支气管肺泡灌洗液(BALF)中T淋巴细胞亚群的特点及其临床意义。方法 采用酶联免疫分析法同时检测48例活动性肺结核及19例非活动性肺结核患者BALF及外周血中T淋巴细胞亚群。结果 活动性肺结核组BALF及外周血中CD4T细胞、CD4/CD8T细胞比值均明显低于非活动性肺结核组(P<0.01)。活动性肺结核患者BALF中CD8T细胞水平明显高于外周血(P<0.05)。空洞性肺结核组BALF及外周血中CD4/CD8T细胞比值明显低于非空洞组。抗结核治疗2个月末BALF及外周血中CD4T细胞、CD4/CD8T细胞比值均明显升高,而BALF中CD8T细胞水平较治疗前降低(P<0.05)。结论 BALF及外周血中T淋巴细胞亚群的检测有助于判断病情、了解抗结核治疗效果及预后。 相似文献
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目的探讨空洞性肺结核的外科治疗适应症,手术方法,术后管理。方法自2000年1月~2009年12月,外科治疗217例空洞性肺结核,其中厚壁空洞73例,薄壁空洞34例,张力空洞26例,慢性空洞127例。痰菌阳性94例,78例均有不同程度耐药。结果择期手术191例,大咯血急症手术26例。空洞清除18例,肺段切除27例,肺叶切除44例,上叶加下叶背段切除34例,上叶加下叶背段病灶清除21例,中下叶切除20例,中上叶切除14例,右全肺切除12例,左全肺切除23例。全组无手术死亡,6例复发,4例术后合并脓胸,4例合并支气管胸膜瘘,5例合并支气管残端瘘,其余全部病例无复发,治愈率97.1%。痰菌阴转率93.6%。讨论外科手术是空洞性肺结核内科治疗失败者较有效的手段。手术原则为宁小勿大,以肺叶切除方式为主。 相似文献
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目的探讨肺结核合并支气管结核的外科治疗效果和手术适应症。方法总结1973年1月至2007年底手术切除的205例肺结核合并支气管结核的临床疗效。全组肺结核包括:原发综合征3例、浸润性肺结核19例、空洞性肺结核53例、慢性纤维空洞性肺结核45例、结核瘤或干酪性肺炎48例、结核性支气管狭窄27例、毁损肺10例。按照支气管结核分型,I型30例、Ⅱ型91例、川型50例、IV型34例。结果全肺切除术15例、全肺切除+胸廓成形术(胸改术)32例、肺叶切除术106例、肺叶切除术+胸改29例、支气管袖状成形术14例,其他手术9例。全组临床治愈率93.0%,手术并发症率为11.2%,手术死亡率为0.05%。结论虽然肺结核合并支气管结核是以抗结核药物为主要治疗方法,但目前仍有部分患者需要外科治疗。手术可提高肺结核合并支气管结核的临床治愈率。 相似文献
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空洞清除术治疗复治菌阳空洞型肺结核临床研究 总被引:6,自引:0,他引:6
目的 寻找通过外科手段治疗内科无法根治的复治耐多药菌阳重症空洞型肺结核的有效途径。方法 1981 ~1998 年6 月采用空洞清除术治疗复治耐药空洞型肺结核104 例。切除覆盖在空洞外侧的肋骨后段,游离相应部位的带蒂肋间组织,剪除空洞外侧壁,彻底清除空洞内容物,刮出新鲜创面,有机酸杀灭可能残留的结核分支杆菌,将准备好的肋间肌瓣填充于空洞残腔内,缝合固定。结果 104 例中出院时治愈103 例(990 % ) ,其中一次手术治愈101 例(981 % ) ,好转1 例(10 % ) 。随访98 例中,复工率96 % ,无手术死亡和复发者。结论 空洞清除术设计合理,是治疗内科无法根治的复治菌阳空洞型肺结核的有效方法。 相似文献
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Nakajima Y 《Kekkaku : [Tuberculosis]》2011,86(12):911-915
[Surgery for pulmonary multi-drug resistant (MDR) tuberculosis] For pulmonary MDR tuberculosis the author (me) had been operating many cases in Fukujuji Hospital JATA in fifteen years. For treatment, the points of operations are as follows: 1) Surgery is one of many treatable events, 2) The strategy is that cavitary foci as major sites of tuberculous expectoration have to be removed and other small foci are treated by not strong chemotherapies, 3) Final goal of surgical treatments is set up preoperatively, and its procedures are stepped up gradually. [Surgery for pulmonary non-tuberculous mycobacteriosis (NTM)] Major sites of pulmonary NTM expectorations are cavitary foci and bronchiectases. Main strategy of surgery for pulmonary NTM is the same as MDR tuberculosis, but multi-resections of cavitary and ectatic foci are more than MDR tuberculosis. Control rate of X-ray images is 80%, negative conversion rate is 88.9% in cases with more than one year postoperatively. But new or residual foci will be gradually growing up for several years postoperatively, so many discussions of surgical strategy for NTM are necessary now. [Surgery for pulmonary aspergillosis] Surgical treatments of pulmonary aspergillosis are difficult. Operations for them are mainly two procedures, resection of foci or no resection. The former is more radical than the later, but mortality rate is higher than usual pulmonary resection. However I think chest surgeons have to challenge to remove aspergillous foci, not aspergilloma but chronic necrotizing pulmonary aspergillosis. 相似文献
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目的总结肺结核肺切除术的手术适应症及经验。方法2000年-2006年,252例肺结核患者接受手术治疗,其中全肺切除术17例,复合肺叶切除术10例,肺叶切除术148例,局限性肺切除术77例;空洞性病变86例,结核球或干酪灶115例,支气管病变或肺不可逆病变32例,毁损肺19例。结果手术死亡2例,痰菌阴转率92.9%,一次手术治愈率92.5%,复发率4.0%,术后发生支气管胸膜瘘11例(4.4%),结核播散6例(2.4%)。结论肺切除术是治疗特殊类型肺结核的有效手段,但应准确掌握手术适应症、把握手术时机。 相似文献
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Wada M Mizutani S Nakajima Y Ito K Mitarai S Hoshino H Okumura M Yoshiyama T Ogata H 《Kekkaku : [Tuberculosis]》2007,82(1):33-37
A 30 years-old-male was referred to our hospital for surgical treatment of multidrug-resistant tuberculosis in April 1998, three years after diagnosis of tuberculosis. All first-line anti-tuberculosis drugs and second-line anti-tuberculosis drugs were resistant on drug susceptibility tests by Ogawa medium. The right upper lobectomy was done because of massive hemoptysis and enlargement of cavitary lesion in June 1998, but this surgical operation was complicated with, bronchial fistula and chronic empyema. Open drainage surgical treatment for chronic empyema was done one month after lobectomy. Sputum culture for M. tuberculosis converted 4 months after the lobectomy, but bacteriological relapse occurred 17 months after initial operation. The new cavitary lesion on middle left lung field developed and sputum smear and culture were continuously positive. Immunotherapy with interferon-gamma via aerosol didn't show any clinical effect. Thiacetazone, sparfloxcin, pyrazinamide, cycloserine was prescribed after 21 months of the initial operation. Four months after changing the regimen sputum smear and culture converted to negative. Chemotherapy was terminated in June 2003, two years after negative conversion. Three years after the termination of treatment no relapse occurred. We considered thiacetazone was effective in this case, because all of the drugs was companied with thiacetazone were resistant by the drug susceptibility tests and were previously used. 相似文献
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Kempker RR Vashakidze S Solomonia N Dzidzikashvili N Blumberg HM 《The Lancet infectious diseases》2012,12(2):157-166
The global emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has led to the re-examination of surgery as a possible adjunctive treatment. We present the case of a 26-year-old HIV-seronegative patient with XDR pulmonary tuberculosis refractory to medical therapy. Surgical resection of the patient's solitary cavitary lesion was done as adjunctive treatment, and a successful outcome with a combination of surgery and drug therapy was achieved. We review the history of surgical therapy for tuberculosis and reports of its role in treatment of MDR and XDR tuberculosis. 26 case series and cohort studies were included, and together showed that surgical resection is beneficial in the treatment of drug-resistant tuberculosis. However, the results might not be applicable in all settings because investigations were observational and typically included patients with less severe disease, and all surgeries were done at specialised thoracic-surgery centres. Well designed studies are needed to establish the efficacy of surgery in treatment of drug-resistant tuberculosis. 相似文献
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E F Haponik M K Hill C C Craighead 《The American journal of the medical sciences》1989,297(4):251-253
Pulmonary sporotrichosis is an uncommon condition that may mimic tuberculosis. We present a patient who, years after antifungal therapy, presented with massive pulmonary hemorrhage. Although such life-threatening hemoptysis caused by sporotrichosis is rare, the possibility of this complication of progressive disease should influence decisions regarding medical and surgical treatment of patients with extensive cavitary involvement. 相似文献