肺放线菌病临床回顾性分析

摘要

目的 探讨肺放线菌病的临床特征、影像学表现、诊治方法及预后,提高临床诊治水平.方法 收集中国知网数据库1975年3月—2017年12月报道的经病理确诊的83例肺放线菌病的临床及影像学资料.结果 本组均表现为咳嗽、咳脓性痰,入院初期均误诊,误诊率100％,误诊时间3 d～8年,误诊为肺炎39例次,肺癌32例次,肺结核20例次,胸腔积液9例次,肺脓肿4例次,支气管扩张、阻塞性肺炎各3例次,炎性假瘤、结核性胸膜炎各2例次,肺结节、肺不张、肺部占位、双肺转移癌、肺化脓性炎、肺肿块、先天性心脏病、肺真菌病各1例次.后进一步完善医技检查,确诊为肺放线菌病,75例予抗生素治疗,8例行单纯手术治疗,其中78例治疗后好转,5例死亡.结论 肺放线菌病缺乏典型的临床症状,选择合适的检查方法是减少误诊的关键.%Objective To investigate the clinical chracteristics, imaging findings, diagnosis and treatment methods, and prognosis of pulmonary actinomycosis, and to improve the level of clinical diagnosis and treatment.Methods The clinical and imaging data of 83 patients with pulmonary actinomycosis confirmed by pathology were searched from CNKI collected between March 1975 and December 2017 and retrospectively analyzed. Results The main clinical symptoms of all patients included cough with yellow purulent sputum. They were misdiagnosed at admission, with a misdiagnosis rate of 100％, and the duration of diagnosis was 3 d-8 years. Major misdiagnosed diseases were 39 cases of pneumonia, 32 cases of lung cancer, 20 cases of pulmonary tuberculosis. 9 cases of pleural effusion, 4 cases of lung abscess, 3 cases of bronchiectasis, and 3 cases of obstructive pneumonia. In addition, there were inflammatory pseudotumor and tuberculous pleurisy in 2 cases, as well as pulmonary nodules, atelectasis, pulmonary placeholder, metastatic carcinoma of both lungs, pulmonary suppurative inflammation, lung mass, congenital heart disease, and pulmonary mycosis in 1 case, respectively. After further perfecting medical examination, diagnosis of pulmonary actinomycosis was confirmed. Seventy-five patients were treated with antibiotics, and 8 patients underwent surgery alone. Of these, the condition of 78 patients was improved after treatment and 5 patients died. Conclusion Pulmonary actinomycosis has atypical clinical symptoms, therefore, appropriate examination methods are the key to reducing misdiagnosis.