支气管内曲霉球的临床特征分析*

Clinical analysis of endobronchial aspergilloma*

摘要:

目的   支气管曲霉球是一种新近定义少见的肺曲霉病，探讨该类型肺曲菌病的临床特点及诊疗策略，以期通过该研究提高对该病的认识水平。方法   该研究通过确诊2例支气管内曲霉球及对文献发表的29例患者临床表现、影像特点、气管镜表现、诊断及治疗等进行回顾性分析。结果   该疾病常见表现有咯血、咳嗽、咳痰,影像学多表现结节或实变影，气管镜表现：主要表现新生物及坏死物阻塞支气管腔，可伴有支气管内实质损伤（和/或）空腔性病变。该病诊断是经气管镜见管腔内新生的肿物或坏死组织，活检物组织病理发现特征性菌丝即可确诊。结论   支气管内曲菌球是肺曲霉菌病的少见类型，气管镜是其诊断及治疗的关键措施，对于当抗真菌治疗无效、肺内病变无吸收甚至增大时，应警惕合并肺部肿瘤的可能。

Abstract:

Objective To discuss the clinical feature of endobronchial aspergilloma approach strategy for diagnosis and therapy. Methods 2 cases of endobronchial aspergilloma were diagnosed and literature review were made in this study. The clinical manifestation, bronchoscopic characters, imaging performances were retrospectively studied. Results The most common complaint was bloody sputum or mild hemoptysis, and chest CT usually revealed a soft tissue mass shadow with the increasing popularity of flexible bronchoscopy, it is being recognized as a necrotic mass causing bronchial obstruction, with or without a parenchymal lesion in cavity. Conclusions Bronchoscopy maybe is the key approach to detect endobronchial aspergilloma. It should be alert to lung cancer when antifungal therapy is not effective and the lesions have no reduction or even increasing.