肺结核球及干酪病灶的活血化瘀治疗

本文报告我院１９９０￣１９９５年间采用２ＨＲＺＳ（Ｅ）／４ＨＲＥ（Ｚ）化疗方案并用复方丹参活血化瘀治疗肺结核球及大块干酪病灶５６例与单纯化疗５２例的结果，分析表明：化疗＋活血化瘀的６个月综合疗效：有效率（显效＋有效）为９６．４％，单纯化疗组则为７６．９％，二者经卡方检验Ｐ〈０．０５，具有差异性。经２￣５年的随访，活血化瘀组有１２例（２１．４％）达到临床治愈，无一例复发。单纯化疗组有６例行外科手术治     

全程督导短程间歇化疗方案治疗涂阳肺结核近远期效果观察

目的观察全程督导短程间歇化疗方案治疗涂阳肺结核的疗效。方法对１２５例初治和２４９例复治涂阳肺结核患者，分别采用２Ｈ３Ｒ３Ｚ３Ｓ３（Ｅ３）／４Ｈ３Ｒ３（异烟肼：Ｈ，利福平：Ｒ，吡嗪酰胺：Ｅ，链霉素：Ｓ，乙胺丁醇：Ｅ）和２Ｈ３Ｒ３Ｚ３Ｓ３Ｅ３／６Ｈ３Ｒ３Ｅ３化疗方案，实施全程督导化疗、管理。结果总完成治疗率为９９．７％；初、复治患者满疗程痰菌转阴率分别为９６．７％和８４．８％；经３年随访，细菌学复发率初治患者为１．８％，复治患者为１０．２％。结论全程督导短程间歇化疗方案对控制结核病具有简便、经济和高效的实用价值。     

纤维支气管镜介入治疗复治肺结核的疗效观察

目的 探讨纤维支气管镜介入治疗复治肺结核的治疗价值。方法 经纤维支气管镜介入肺部病灶内注入异烟肼及链霉素，加化疗治疗复治肺结核158例，与单纯化疗156例进行对照研究。结果 经纤维支气管镜介入注药治疗，观察组疗程结束后痰菌阴转率96．8％，病灶显效率89．9％，空洞闭合率48．1％，均显著高于单纯化疗组的62．2％、58．3％及16．0％（P〈0．01-0．05）。结论经纤维支气管镜介入注药治疗加化疗治疗复治肺结核，疗效显著优于单纯化疗。     

不同疗程含异烟肼、利福平方案对尘肺结核近远期疗效观察

目的探讨以ＨＲ为主不同疗程化疗方案对菌阳尘肺结核的近远期疗效。方法将７９例菌阳病例分为９月组（Ｍ９：２ＳＨＲＺ／７ＨＲＥ）、１２月组（Ｍ１２：２ＳＨＲＺ／１０ＨＲＥ）、１８月组（Ｍ１８：２ＳＨＲＺ／１０ＨＲＥ／６ＨＲ），分别采用不同方案治疗。疗效考核以痰菌为主要依据。满疗程随访５～８年。结果Ｍ９、Ｍ１２、Ｍ１８组满疗程痰菌阴转率分别为８３％、９６％、９５％，随访期间痰菌复阳率分别为４１％、４％、５％，其中随访１～４年痰菌复阳率分别为６％、８％、２％、２％，第５～８年无复阳病例。结论１２月方案（２ＳＨＲＺ／１０ＨＲＥ）对复治菌阳尘肺结核有效；随访时间以４～５年为宜。     

食管静脉曲张大出血硬化治疗后再出血分析

１９９１年１月起我们用５％鱼肝油酸钠快速食管静脉内注射法对食管静脉曲张破裂大出血患者进行连续硬化剂注射（ＥＳ）治疗，共１７６例３５８例次。复发性出血２１例，占１２％。１．一般资料：ＥＳ后近期复发出血２１例，男１７例，女４例。肝功能ｃｈｉｌｄ　Ａ级４例，Ｂ级９例，Ｃ级８例。复发出血５０例次，其中单纯黑便８例次，呕血及便血量５００～１０００　ｍｌ　３６例次，出血量＞１０００　ｍｌ　６例次。复发出血１次者１０例，２次９例，３次、４次各１例。２．复发出血距上次ＥＳ时间：４８　ｈ内７例次，２～７　ｄ　５例…     

经纤维支气管镜导管介入治疗耐多药肺结核

目的 探讨纤维支气管导管介入对耐多药肺结核的治疗价值。方法 经纤维支气管镜导和介入空洞病灶内注入氧氟沙星及丁胺卡那霉素加化疗治疗耐多药肺结核４８例，与单纯化疗４０例进行对照研究。结果 经纤维支气管镜导管介入治疗组疗程结束时痰菌阴转率９２％，病灶显效率９６％，空洞闭合率２７％，均显著高于单纯化疗组的６３％、５８％及１０％（Ｐ〈０．０１－０．０５）。结论 经纤维支气管镜导管介入空洞病灶内主药加化疗治疗     

综合序贯介入治疗原发性肝癌疗效分析

目的为进一步提高中晚期肝癌的治疗效果，采用综合序贯介入治疗，并对其疗效进行分析。方法３６例原发性肝癌，综合治疗组１６例，肝功能ＣｈｉｌｄＡ级１０例，Ｂ级６例。癌块＜５ｃｍ者１例，＞５ｃｍ者１５例，合并门脉癌栓者７例。肝动脉栓塞化疗（ＴＡＥ）组２０例，ＣｈｉｌｄＡ级及Ｂ级各１０例，癌块＜５ｃｍ者２例，＞５ｃｍ者１８例，门脉癌栓７例。ＴＡＥ组按常规行ＴＡＥ治疗。综合治疗组的措施是：ＴＡＥ．Ｂ超引导下门静脉栓塞化疗、无水乙醇肝内注射（ＰＥＩ）、Ｂ超引导下门脉癌栓的无水乙醇注射治疗、碘油及化疗药物肝内直接注射、其他措施有免疫制剂及９０Ｙ－玻璃微球肝内注射等，以上治疗序贯进行。结果随访时间３年，综合治疗组病程４～３４个月，最长生存湖３４个月（存活），半年生存率为８７．５％，一年生存率为５６．２％．ＴＡＥ组病程３－２９个月，最长生存期２９个月（死亡）。半年生存率为６０．０％，一年生存率为２０．４％。结论综合序贯治疗的半年及一年生存率均较单纯ＴＡＥ组显著延长，在改善肝癌预后上起重要作用。     

165例Ⅲ期小细胞肺癌的外科治疗评价

对胸外科１９７９年～１９９１年底经手术切除的１６５例Ⅲ期小细胞肺癌（ＳＣＩＣ）的治疗效果进行分析，并将其中的８７例综合治疗病例与７８例单纯手术病例进行对比讨论。同时，就综合治疗组中术前化学治疗（化疗）和（或）放射治疗（放疗）对预后的影响做了观察。全组５年生存率占１６．６％。ＴＮＭ分期５年生存率Ⅲａ期达２０．４％，Ⅲｂ期为０。综合治疗５年生存率占２２．８％，单纯手术５年生存率占７．９％。结果显示：Ⅲａ期ＳＣＬＣ综合治疗优于单纯手术治疗；综合治疗组中Ｎ＿２术前化疗和（或）放疗病例较术后化疗和（或）放疗病例预后变差；手术适应证应限于Ⅲａ期病例。     

经纤维支气管镜药物灌注治疗耐多药空洞型肺结核疗效分析

目的探讨纤维支气管镜导管介入对耐多药肺结核的治疗价值。方法经纤维支气管镜导管介入空洞并注入抗痨药物治疗空洞性肺结核102例,与单纯化疗组106例进行对照研究。结果痰菌阴转率89％,病灶吸收率92％,空洞闭合率50％,均显著高于单纯化疗组的54％、69％、23％（P〈0．01～0．05）。结论经纤维支气管镜介入注药治疗耐多药肺结核,疗效优于单纯化疗组且无明显毒副作用。     

脑内胰岛移植治疗Ⅰ型糖尿病的远期疗效观察

应用短期培养的人胎儿胰岛组织脑内移植治疗Ⅰ型糖尿病患者３０例，年内有效２６例（８７％）；移植后２～３年随访２１例，有效１７例（８１％），失效４例（１９％）；４～５年随访１８例，有效１５例（８３．３％），失效３例（１６．７％）；６～７年随访１５例，有效９例（６０％），失效６例（４０％）。在移植有效病例中，有效维持时间为４．９±１．７（１．２～７）年，１１例完全或间断停用胰岛素治疗达０．３～７（３．１２±１．９６）年，其中超过３年者６例。结果表明，脑内胰岛移植治疗Ⅰ型糖尿病临床效果显著，移植物在部分患者脑内能长期存活。     

Thin-rim enhancement in Gd-DTPA-enhanced magnetic resonance images of tuberculoma: a new finding of potential differential diagnostic importance.

The article describes rim enhancement seen on Gd-DTPA-enhanced magnetic resonance (MR) images of two patients with tuberculoma. Pathologic examination of the surgical specimens disclosed that the peripheral portion of the tuberculoma, which showed contrast enhancement, was composed mainly of a fibrous capsule and epithelioid granulomas and that the central zone, which showed no contrast enhancement, was composed of caseous necrotic material. In a retrospective study of MR images from 20 consecutive cases of surgically proven bronchogenic carcinoma, none showed a thin enhancing rim on postcontrast MR images. Although confirmation of these findings must await further experience, the postcontrast MR findings described here may prove to be of value in distinguishing tuberculoma and possibly other granulomatous lesions from bronchogenic carcinoma.     

5 050例肺结核病患者病理学观察

目的总结肺结核病的病理形态学改变及其与联合化疗方案之间的关系。方法观察５０５０例肺结核患者的病理学改变,并对ＨＳＰ、ＨＲＳ和ＨＲＺＳ三种不同联合化疗方案与各型肺结核病理变化的关系进行分析。结果经ＨＲＳ和ＨＲＺＳ治疗的病例中,干酪空洞和纤维空洞手术切除率明显下降,与ＨＳＰ联合化疗方案相比有显著性差异（Ｐ＜０．０１）。经ＨＳＰ、ＨＲＳ和ＨＲＳＰ化疗方案治疗后,结核球的手术切除率分别为２６．８２％（８９７／３３４５）、４１．２４％（４６４／１１２５）和４７．８％（２７７／５８０）,呈现上升趋势（Ｐ＜０．０１）。并发现４２例净化性空洞患者。结论并用利福平和吡嗪酰胺的联合化疗对肺结核病理类型有一定影响,导致结核球比例上升,干酪和纤维空洞比例下降。在肺结核的分类中对结核球应加以考虑     

肺结核球手术指征的探讨

目的　讨论肺结核球误诊原因,提出手术指征及手术方式。方法 报告及分析108例肺结核球病例资料,结合文献进行讨论。结果 肺结核球108例,占同期手术总数2.2%。术前误诊37例,其中误诊为肺癌30例 (病灶＜3cm者22例),良性肿瘤6例,曲菌球1例。X线胸片表现不典型40例 (病灶边缘有毛刺、分叶状、伴有肺门及纵隔淋巴结肿大等)。病灶发生在肺上叶85例 (78.7%),有结核中毒症状者58例 (53.8%)。30例因抗结核治疗效果不佳而手术。结论 在肺部孤立病灶的诊断中应考虑结核球的可能,应结合临床全面分析,尽可能找出组织病理学依据,使部分结核球病人避免手术治疗。结合文献资料提出肺结核球的手术指征及手术方式。     

B超引导下胸膜结核瘤内局部注药治疗临床分析

目的评价B超引导下胸膜结核瘤内局部注药治疗效果。方法选择我院胸膜结核瘤病例16例,给予B超引导下胸膜结核瘤内注药治疗,分别于治疗后1月、6月、12月观察治疗效果,对比病灶变化。结果观察1月末、6月末、12月末结核球变化。复查胸部CT,结核球平均直径明显减小,12月末10例完全吸收(62.5%),有或无胸膜增厚;2例病灶内钙化(12.5%);4例明显缩小(25%)。结论 B超引导下胸膜结核瘤内穿刺注药是治疗结核瘤安全和有效的方法,值得介绍。     

Perfusing chemotherapy by percutaneous lung puncture “holing” for pulmonary tuberculoma—a ten-year single center experience

Background

Pulmonary tuberculoma is a special form of secondary pulmonary tuberculosis, with a poor response to drug treatment. We used the method of drug administration via percutaneous lung puncture “holing” to treat pulmonary tuberculoma and observe its short- and long-term efficacy, summing up our 10-year clinical experience.

Methods

A total of 54 patients with pulmonary tuberculoma were included in this study. They themselves were taken as the control group. Three to six months of conventional anti-tuberculosis treatment was conducted firstly. Then those patients with no changes of sizes in tuberculoma were recommended to receive drug administration via percutaneous lung puncture. Isoniazid (INH, 0.1 g) and amikacin (AMK, 0.2 g) were injected into tuberculoma (once or twice per week, 10 times as a course of treatment).

Results

After two months of drug treatment by lung puncture, the sputum smear test showed the negative conversion rate of tubercle bacillus was 87% (13/15), and the positive conversion rate was 8% (3/39). The tuberculosis bacillus culture indicated that the negative conversion rate was 100% (7/7). The reexamination after one year showed the negative conversion rate of tubercle bacillus in the sputum smear test was 80% (4/5). About 58% (31/54) of tuberculoma disappeared or significantly reduced, in which, 40% (21/54) of tuberculoma disappeared. The tuberculoma diameter reduced from 3.6 cm × 2.8 cm to 1.7 cm × 1.1 cm on average. Side-effects included postoperative pneumothorax 9% (5/54), hemoptysis 7% (4/54) and fever 11% (6/54). A total of 34 patients were followed up for five years, and the disappearance rate of tuberculoma was up to 47% (16/34), with no recurrence.

Conclusions

The drug administration via percutaneous lung puncture—“holing” in pulmonary tuberculoma takes a significant effect obviously, good short- and long-term effects and less side effects.KEY WORDS : Percutaneous lung puncture, pulmonary tuberculoma, holing     

Chest wall tuberculoma with tumor-like appearance

We report a rare case of chest tuberculoma with tumor-like appearance of which diagnosis was made by surgery. A 40-year-old woman presented to our hospital with a complaint of a right chest mass. Her past history was pulmonary tuberculosis. One year prior to this presentation, she was treated. Chest MRI revealed a solid and oval mass in the right lateral chest wall. Then, surgical resection was performed. Histopathological examinations revealed caseous necrosis, epithelioid cell granuloma, and multinucleated Langhans' giant cells, but no neoplastic cell was found. We confirmed that the mass was clinically compatible with tuberculoma. The characteristic presentation of the chest wall tuberculosis is abscess, which is frequently cystic, doughy, or soft. However, there is no report with chest wall tuberculoma as the initial presentation of tuberculous lesion arising in chest wall in a review of the English literature.     

Clinical and morphological characterizations of first detected cases of caseous pneumonia and its outcomes under conditions of current antibacterial therapy

The paper provides a clinical and X-ray picture of first detected caseous pneumonia. It shows the potentialities of currently available antibiotic therapy used in patients with this diagnosis. At the same time closure of decay cavities and eradication of bacteria can be achieved only in 29% of cases. The major outcome of caseous pneumonia is fibrocavernous tuberculosis. Thus, surgical methods must play an important role in curing such patients. A detailed morphological characterization of surgical materials has demonstrated that active chemotherapy may result in 3 types of caseous pneumonia outcomes: acute progression, chronicity tended to progression, and the development of fibrocavernous tuberculosis. The morphological studies have provided evidence for the validity of the clinical and X-ray dynamics of the disease and for the correctness of choice of surgical policy.     

Lack of superiority of steroids plus plasma exchange to steroids alone in the treatment of polyarteritis nodosa and Churg-Strauss syndrome. A prospective, randomized trial in 78 patients.

OBJECTIVE. To define the most effective treatment for polyarteritis nodosa (PAN) and Churg-Strauss syndrome (CSS). METHODS. We conducted a prospective, randomized, multicenter trial in which 78 patients were randomly assigned to receive either prednisone and plasma exchange (group A; n = 36) or prednisone alone (group B; n = 42) as first-line treatment of PAN and CSS. Patients with hepatitis B virus-related PAN were not included in this study. The end point of the study was control of the disease (recovery and remission) or death. RESULTS. Clinical symptoms and laboratory findings did not differ statistically in the 2 groups at study entry. Initial control of the disease was similar in both groups. The assigned treatment was stopped in 16 patients because of lack of efficacy. Oral cyclophosphamide or dapsone therapy reversed the disease evolution in 7 of these 10 group A patients and in 4 of these 6 group B patients. At 7 years of followup, 56 patients had completely recovered (27 in group A, 29 in group B), 7 patients were in clinical remission, and 15 patients had died (19.2%; 6 group A patients and 9 group B patients). The prednisone-plasma exchange combination was no more beneficial than corticosteroids alone in preventing relapses over the long term. There was no significant difference in the 7-year cumulative survival rates of the two groups (83% and 79%, respectively). CONCLUSION. Based on our data, we conclude that combined treatment with prednisone and plasma exchange is not superior to treatment with prednisone alone and must not be systematically employed for initial treatment of PAN and CSS. In most cases, cyclophosphamide as second-line treatment is effective and well tolerated.     

“一站式”杂交手术在Stanford A型主动脉夹层患者治疗中的应用价值

目的研究"一站式"杂交手术在Stanford A型主动脉夹层患者治疗中的应用价值。方法选取2015年至2018年期间到北京大学深圳医院就诊的200例Stanford A型主动脉夹层患者进行研究,按数字表法随机分为研究组及常规组,每组100例。结果研究组患者addition EuroSCORE>7%以及Logistics EuroSCORE>6%的比例明显高于常规组,差异有统计学意义(66.0%vs. 36.0%,P<0.001;74.0%vs. 39.0%,P<0.001)。研究组患者比常规组患者具有更高的手术风险,差异有统计学意义(P<0.05)。研究组患者体外循环时间以及主动脉阻断时间比常规组均明显缩短,术后重症监护病房初次停留时间比常规组明显长,差异有统计学意义(P<0.001)。两组患者围术期死亡及术后30 d主要复合不良事件、脑卒中、截瘫、肾功能不全需血液透析辅助治疗的发生率比较,差异均无统计学意义(P>0.05)。结论 "一站式"杂交手术在Stanford A型主动脉夹层患者治疗能够缩减体外循环时间及主动脉阻断时间、降低患者手术创伤、提高手术安全。     

母牛分枝杆菌菌苗辅助治疗初治菌阳肺结核的临床分析

目的　观察和评价母牛分枝杆菌菌苗 (微卡菌苗)在初治菌阳肺结核治疗中的作用。方法 采用随机配对分组法,分微卡菌苗治疗组 (A组,84例 )和对照组 (B组,84例 )。 2组化疗方案均为2HRZE 4HR,A组加用微卡菌苗治疗 2月,B组不用微卡菌苗。结果 A组第 1月涂片阴转率36.9%,培养阴转率 47.6%;第 2月涂片阴转率 79.8%,培养阴转率 85.7%。B组第 1月涂片阴转率19.0%,培养阴转率 17.9%;第 2月涂片阴转率 53.8%,培养阴转率 67.9%。前 2月痰菌阴转率A组显著高于B组 (P＜0.01 )。疗程满 6个月后A组涂片阴转率 98.8%,培养阴转率 97.6%;B组涂片阴转率 96.4%,培养阴转率 97.6%。A组和B组治疗 6个月痰菌阴转率无显著性差异 (P＞0.05)。病灶吸收好转及空洞缩小关闭速度,A组优于B组。A组的细胞免疫功能显著改善。随访A组和B组的细菌学复发率分别为 1.3%和 2.6% (P＞0.05)。结论 微卡菌苗能改善初治菌阳肺结核患者的细胞免疫功能,加快痰菌阴转、病灶吸收及空洞缩小关闭的速度,不良反应少且轻微。微卡菌苗可用作初治菌阳肺结核的免疫治疗。