本文選題：腐生性　切入點：肺曲霉球病　出處：《浙江大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：背景腐生性肺曲霉病是曲霉菌感染的最主要形式,由腐生菌寄生于肺部原有空洞性病變形成,主要通過煙曲菌形成肺曲菌球(PA)或慢性壞死性肺曲菌病(CNPA),因肺內(nèi)病變可發(fā)生大咯血,常危及生命,外科手術(shù)是目前普遍可接受的能唯一治愈肺曲霉病的方式。 目的探討腐生性肺曲霉菌病的臨床特點、影像學(xué)特征、手術(shù)方式及術(shù)后并發(fā)癥,病理學(xué)特點,隨訪資料,以期通過本研究提高對該病的認識水平,幫助我們掌握外科手術(shù)適應(yīng)征及最佳手術(shù)時機,以便于恰當(dāng)選擇手術(shù)病人,使病人從外科手術(shù)中最大程度獲益,控制圍手術(shù)期并發(fā)癥及死亡率在可接受水平。 方法對浙江大學(xué)附屬第一醫(yī)院心胸外科及呼吸內(nèi)科2006年～2011年間確診的50例腐生性肺曲霉菌病住院病例進行回顧性研究,對比分析27例慢性壞死性肺曲菌病和23例肺曲霉球的基礎(chǔ)疾病、臨床特點、實驗室檢查、影像學(xué)特征、病理學(xué)特點和治療方法及預(yù)后。 結(jié)果腐生性肺曲霉病好發(fā)于中老年患者,且都好發(fā)于肺部原有空洞或者囊性空腔等結(jié)構(gòu)性病變處,如空洞型肺結(jié)核及空洞性支氣管擴張等。單因素分析證實慢性壞死性肺曲菌病和肺曲霉球在性別,年齡,臨床癥狀方面無顯著性差異。影像學(xué)上,CNPA和肺曲霉球均可出現(xiàn)空氣新月征,均好發(fā)于兩肺上葉,但前者有胸膜增厚,空洞周圍浸潤陰影、厚壁空洞和洞壁不規(guī)則等特征,對比分析證實兩者在影像學(xué)特征上存在顯著性差異。病理學(xué)上,CNPA和肺曲霉球都可見銳角分支、有隔膜的曲霉菌絲,但前者有組織出血、壞死、微膿腫和炎性反應(yīng)細胞浸潤等特征,對比分析證實兩者在病理學(xué)特征上存在顯著性差異。單因素分析后證實大咯血,體重減輕,是術(shù)后并發(fā)癥危險因素。5年累計生存分析,PA組為88%,CNPA組為81.3%,多因素通過COX風(fēng)險比例回歸分析證實年輕,無大咯血是生存預(yù)后有利因素。 結(jié)論組織病理學(xué)是鑒別肺曲菌球(PA)或慢性壞死性肺曲菌病(CNPA)金標(biāo)準(zhǔn),空氣新月征,是腐生性肺曲霉病特征性CT表現(xiàn),大咯血是腐生性肺曲霉病術(shù)后獨立危險因素。在可手術(shù)患者中,無癥狀患者亦推薦早期手術(shù)治療,可阻止發(fā)生大咯血,提供理想的可永久治愈機會。單純肺曲菌球,手術(shù)切除完整,術(shù)后無癥狀患者不推薦常規(guī)預(yù)防性抗真菌治療,而慢性壞死性肺曲菌病術(shù)后需預(yù)防性抗曲菌治療,存在肺內(nèi)多發(fā)病灶亦需抗曲菌治療。
[Abstract]:Background Aspergillus pneumoniae is the main form of aspergillus infection. Pulmonary aspergillosis (PAA) or chronic necrotizing pulmonary aspergillosis (CNPAA) is mainly formed by aspergillus fumigatus. Because massive hemoptysis can occur in the lung, surgical operation is the only commonly accepted way to cure pulmonary aspergillosis. Objective to investigate the clinical, imaging, operative and postoperative complications, pathological features and follow-up data of pulmonary aspergillosis in order to improve the understanding of the disease. It helps us to grasp the surgical adaptation sign and the best time of operation, so as to select the patients properly, to maximize the benefits of surgery, and to control the perioperative complications and mortality at acceptable level. Methods A retrospective study was conducted on 50 cases of atrophic pulmonary aspergillosis diagnosed in the Department of Cardiothoracic surgery and Department of Respiratory Medicine in the first affiliated Hospital of Zhejiang University in 2006. A comparative analysis was made of 27 cases of chronic necrotizing pulmonary aspergillosis and 23 cases of pulmonary aspergillosis. The clinical features, laboratory findings, imaging features, pathological features, treatment methods and prognosis were compared and analyzed. Results Pulmonary aspergillosis was more common in middle-aged and elderly patients, and most of them occurred in structural lesions such as the original cavity or cystic cavity of the lung. Univariate analysis showed that chronic necrotizing pulmonary aspergillosis and pulmonary aspergillosis were found in sex, age, and age. There was no significant difference in clinical symptoms. Both CNPA and Aspergillus pulmonis appeared air crescent sign on imaging, which occurred in both upper lobes of lung, but the former was characterized by pleural thickening, infiltration and shadow around cavity, thick wall cavity and irregular wall, etc. The contrast analysis showed that there was a significant difference in the imaging characteristics between the two groups. Both CNPA and Aspergillus pneumoniae could be seen in pathology with an acute angle branch with membranous aspergillus, but the former had tissue bleeding and necrosis. The pathological characteristics of microabscess and inflammatory response cell infiltration were significantly different from those of the control group, and the results of univariate analysis showed significant hemoptysis and weight loss. 5 years cumulative survival analysis was 81.3% in PA group. Multiple factors were confirmed by proportional regression analysis of COX risk. No hemoptysis was a favorable factor for survival and prognosis. Conclusion histopathology is the gold standard for differentiating pulmonary aspergillosis (PAA) from chronic necrotizing pulmonary aspergillosis (CNPA). The air crescent sign is the characteristic CT manifestation of pulmonary aspergillosis. Massive hemoptysis is an independent risk factor for postoperative pulmonary aspergillosis. Among operable patients, asymptomatic patients also recommend early surgical treatment to prevent massive hemoptysis and provide an ideal permanent cure. Postoperative asymptomatic patients do not recommend routine prophylactic antifungal therapy, while chronic necrotic pulmonary aspergillosis needs preventive anti-aspergillus treatment, and multiple pulmonary lesions also need anti-aspergillus treatment.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R519

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本文編號：1601437