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目的探讨对初治肺结核临床治愈后残留空洞的诊断再评价。方法收集2003年1月至2007年6月上海市(复旦大学附属)公共卫生临床中心和武汉市结核病防治所对初治痰菌阳性肺结核在完成短程化疗后痰菌阴转、达到临床治愈、但X线胸片检查仍残留空洞的67例患者进行支气管肺泡灌洗(BAL)和经皮肺穿刺活检(PLB),对肺结核合并疾病的诊断进行再评价。结果67例患者BAL证实结核杆菌阴性,经过知情同意后,其中的59例患者进行了PLB 62例次,发现肺癌2例次(鳞癌1例,腺癌1例),真菌感染5例次(曲霉菌2例、隐球菌2例、白色念珠菌1例)、结核分枝杆菌阳性5例次、细菌培养阳性3例次(铜绿假单胞菌、鲍曼不动杆菌、产酸克雷伯菌各1例次)。结论即使在肺结核诊断成立并且治疗有效,对肺结核合并疾病的诊断也应该受到高度重视,临床治愈后若残留空洞,仍有必要对诊断进行评价,以免延误肺结核合并的肿瘤和感染性疾病的诊断,必要时需进行BAL或PLB明确诊断。
Objective To investigate the re-evaluation of the diagnosis of residual cavity after initial clinical treatment of pulmonary tuberculosis. Methods From January 2003 to June 2007, Shanghai Municipal Public Health Clinical Center Affiliated to Fudan University and Wuhan Tuberculosis Prevention and Treatment Center collected clinical sputum negative conversion from sputum positive sputum positive pulmonary tuberculosis after the completion of short-course chemotherapy, Sixty-seven patients with residual voids on X-ray were evaluated for bronchial alveolar lavage (BAL) and percutaneous lung biopsy (PLB) for the diagnosis of pulmonary tuberculosis. RESULTS: Sixty-six patients with BAL were confirmed negative for Mycobacterium tuberculosis. After informed consent, 59 cases of PLB performed 62 cases of PLB and found 2 cases of lung cancer (1 case of squamous cell carcinoma and 1 case of adenocarcinoma) and 5 cases of fungal infection 2 cases of Aspergillus, 2 cases of Cryptococcus neoformans, 1 case of Candida albicans), 5 cases of Mycobacterium tuberculosis positive, 3 cases of positive bacterial culture (Pseudomonas aeruginosa, Acinetobacter baumannii, 1 case of bacteria each). Conclusion Even in the diagnosis and treatment of pulmonary tuberculosis, the diagnosis of tuberculosis complicated by the disease should be given high priority. If the residual cavity remains after the clinical cure, it is still necessary to evaluate the diagnosis so as not to delay the diagnosis of tuberculosis complicated with the tumor and infectious diseases. Necessary to make a clear diagnosis of BAL or PLB.