纤维支气管镜下微波联合伊曲康唑治疗肺曲菌球病疗效观察.docVIP

纤维支气管镜下微波联合伊曲康唑治疗肺曲菌球病疗效观察 　　[摘要] 目的 探讨经纤维支气管镜（纤支镜）下应用微波技术联合伊曲康唑治疗肺曲菌球病的疗效观察及安全性。方法 11例病人经纤支镜取材或痰菌培养诊断为肺曲菌球病。纤支镜到达病变部位后，经活检孔导入微波电极，对病灶进行电凝治疗，使病灶发生坏死。伊曲康唑经纤支镜给药孔注入到病灶部位，每周1次，疗程约3-6次，对上述病例的治疗效果进行追踪半年。结果 11例临床病例中，疗程结束后，治愈率72.7%，有效率90.9%，1例患者未完成疗程。结论 经纤支镜下微波联合伊曲康唑对肺曲菌球病进行治疗，能对多数病例病灶进行清除，该治疗方法可行，损伤小，有较好疗效，可作为除手术外，肺曲菌球病另一有效治疗方法。 　　[关键词] 纤维支气管镜； 肺曲菌球病； 微波； 伊曲康唑； 治疗 　　[中图分类号] R562.2[文献标识码] B[文章编号] 1005-0515（2011）-07-024-01 　　[Abstract] Objective To evaluate the fiberoptic bronchoscope (bronchoscopy),the application of microwave technology combined Itraconazole treatment of pulmonary aspergilloma patients efficacy and safety. Methods 11 patients drawn by bronchoscopy or sputum culture for the diagnosis of pulmonary aspergilloma patients. Bronchoscope to reach the lesion, the biopsy holes into the microwave electrode coagulation treatment of lesions, the lesion necrosis. Itraconazole administered through the bronchoscope into the hole to the lesion site, 1 week of treatment about 3-6 times the therapeutic effect of these cases to track for six months. Results 11 clinical cases, the end of treatment, the cure rate of 72.7%, efficiency 90.9%, one patient did not complete the course. Conclusion The combined microwave under fiberoptic itraconazole for pulmonary aspergilloma treated patients, lesions can be removed in most cases, the treatment method is feasible, the damage is small, has a good effect, as in addition to surgery, the lung aspergilloma patients other effective treatment. 　　[Keywords] Bronchoscopy; Pulmonary aspergilloma disease; Microwave; Itraconazole; Treatment 　　近年来，肺曲菌球病的发病率上升，由于抗真菌药物难以有效地渗入空洞及曲菌球内，已形成的曲菌球又难以通过堵塞或者狭窄的支气管排出，因而单纯抗真菌药物治疗无效或效果欠佳，手术切???病灶被认为是治疗肺曲菌球病的唯一有效手段[1-2]。但外科手术常受到手术损伤大，风险高，并发症多，病人不愿手术或肺部病灶广泛，心肝肾功能差而不能手术等条件，因而探讨有效而又损伤小的治疗方法成为临床需要解决的问题。我们采用纤支镜下微波联合伊曲康唑治疗肺部曲菌球病。 　　1 临床资料和方法 　　1.1 临床资料 11例病人经纤支镜取材或痰菌培养诊断为肺曲菌球病，男8例，女3例，年龄介于35-73岁，平均年龄52岁，病史约3个月～8年。既往病史 肺结核7例，支气管扩张3例，慢性肺脓肿1例。绝大多数病例有反复咳嗽、咳痰、咯血病史，咯血丝痰0-100ml/次有9例，咯血100-500ml/次有2例，肺部CT所示病灶，右肺上叶