摘要目的 探讨肺曲菌球的诊断和治疗方法. 方法 分析2001-2005年武汉市结核病院收治的40例肺曲菌球患者的临床诊治情况. 结果 40例中男24例,女16例,年龄17～61岁,平均37.7岁.40例中支气管扩张症和空洞型肺结核37例,肺囊肿2例,空洞型肺癌1例;咯血33例,反复间断小量咯血(＜20 ml/次)27例,大咯血6例;咳嗽、咳痰5例次;发热、盗汗3例次.40例患者均无基础疾病及长期使用抗生素史.术前、术后曲菌球的诊断符合率为60%(24例),原发病的诊断符合率为40%(16例).手术切除肺叶39例,全肺切除1例.死亡1例.随访1年,仅1例抗曲霉治疗6个月,余均未按要求服药.除2例大咯血患者复发外,余均痊愈. 结论 肺曲菌球多见于支气管扩张症及空洞型肺结核患者.多数患者可出现反复小量咯血.术前曲菌球和原发病诊断较困难.可根据病情采取不同的治疗方法,是否应首选手术或预防性手术有待商榷.出院后的抗曲霉治疗似乎并非必要.

abstractsObjective To describe the treatment and diagnosis of pulmonary aspergilloma.Methods The clinical data of 40 cases of pulmonary aspergilloma were analyzed.Results There were 24 men and 16 women,aged 16-61 years.There were 37 cases with pulmonary tuberculosis with cavity or bronchiectasis Hemoptysis,cough,fever and sweat were present in 33,5,and 3 cases respectively.The discontinuity repeatedly haemoptysis with a little(＜20 mL/time)were 27 cases.A correct diagnosis of aspergilloma was made in 60%cases(n=24)before surgery.Lobectomy was performed in 39 cases,and unilateral lung removal in 1 case.Following surgery,39 cases were cured,and 1 case died Conclusion Pulmonary aspergilloma occurs mostly in middle-aged patients with cavitary or bronchiectatic pulmonary tuberculosis.Misdiagnosis of both the underlying tuberculosis and aspergilloma was common before surgery.Surgery is indicated for patients with heavy hemoptysis,but the value of antifungal therapy needs further studies.