肺结核化疗中肺不张20例分析

目的　提高对肺结核化疗中肺不张的认识。方法　 2 0例肺结核住院化疗中发生肺不张的时间、影像学特点、纤支镜检查、痰细胞学病理及治疗转归进行分析。结果　 2 0例 CT检查发现肺门及纵隔淋巴结肿大 ;纤支镜呈外压性改变 15例 ,结节阻塞 5例 ;7例涂片抗酸杆菌阳性。 17例依原方案治疗 ,12例加用激素。肺复张时间在2 0～ 6 3d,3例疑肺癌手术治疗。2 0例均临床治愈。结论　肺结核化疗中肺不张少见 ,发病原因为化疗反应性淋巴结炎 ,部分为支气管结核暂时恶化。原方案化疗可使肺复张 ,加用激素则促进其复张。

Clinical Analysis on 20 Cases of Aclectasis during Chemotherapy of Pulmonary Tuberculosis

Objective To further understanding of aclectasis during chemotherapy of pulmonary tuberculosis.Methods The onset, image characteristics fibrobronchoscopic, pathological findings and therapy evolution were analyzed on 20 aclectasis patients during chemotherapy of pulmonary tuberculosis. Results All patients were found to have lymphnode enlargement in the hilas of lung and mediastinum. There were external compression in 15 cases and obstruction in 5 cases under the bronchoscope. Tubercle bacillus was positive by sputum in 7 cases. Prednisone was added based on the primary programme in 12 of the 17 cases. 3 cases suspected of lung cancer were operated. Timing occurred between days 20 and 63.Conclusion Aclectasis during chemotherapy of pulmonary tuberculosis is rare.It is the result most from reactive lymphadenitis in chemotherapy and partly from temporary exacerbation of bronchial tuberculosis. Continuation of chemotherapy may reinflat lung and the use of hormone can further accelerate it.