摘要
目的探讨肺毛霉病的临床表现、诊断和治疗方法。方法本组２例采用纤维支气管镜、开胸探查和痰检查，经病理或真菌培养确诊。结果随着广谱抗生素、抗肿瘤药物、皮质激素和器官移植的广泛应用，发病率有增高趋势。病死率极高，国外报道为８０％，局限于肺部者为６５％，播散型高达９６％。国内报道的１０余例仅１例存活，且多为尸检后明确诊断。本组２例确诊后，其中例１两次行肺叶切除术并于手术前后采用氟康唑治疗，例２单用氟康唑治疗，均痊愈出院。结论对临床可疑病例应及时确诊，有手术适应证者应积极手术切除。
Objective To describe the characteristic of pulmonary mucormycosis (PM) and to evaluate the methods of diagnosis and treatment. Methods Two patients successfully treated in our hospital were reported and more than 250 cases in English and Chinese literature were reviewed. Results A 32 year old previously healthy woman farmer presented with fever, cough, sputum and hemoptysis for 8 months. Her chest radiograms showed large bilateral masses upper lobes. Open lung biopsy confirmed the diagnosis of PM. She was successfully treated with bilateral upper lobectomy with a 3 month interval between the 2 operations and combined therapy with fluconazole for 3 weeks before and after the operations. Case 2 was a 56 year old woman who had been on mechanical ventilater and given high dose of steroids and antibiotics for severe asthmatic attack and pneumonia. She presented with high fever and purulent sputum and had lung infiltrations on chest film. The diagnosis of PM was made by 2 positive sputum culture of mucor mycosis. She was cured by fluconazole. Conclusion From the literature and the two reported cases the underlying predisposing conditions of PM were malignancy, diabetes mellitus, chronic renal failure and treatment with high dose of steroids and antibiotics. The diagnosis was dependent on transbronchial lung biopsy, open lung biopsy, sputum and broncho alveolar lavage analysis and transthoracic needle aspiration. The mortality of PM was very high. However, early diagnosis and surgical intervention of isolated PM combined with fluconazole may signigficantly improve the survival.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1998年第5期327-329,共3页
Chinese Journal of Internal Medicine
