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目的探讨肺毛霉病的临床表现、诊断和治疗方法。方法报道2006年我院收治的、经纤维支气管镜检查和组织病理确诊且具有完整资料的3例肺毛霉感染病例并结合国内外文献进行复习。结果 3例均为农民,女2例,男1例,年龄42～48岁。例1和例2为糖尿病酮症酸中毒患者,例1在确诊次日因大咯血死亡;例2应用大剂量两性霉素 B(总剂量2 g)治愈;例3为肺鳞癌右上叶切除术后伴支气管狭窄,通过应用大剂量两性霉素 B(总剂量1.5 g)和支气管镜介入治疗成功治愈;例2和例3随诊0.5～1年均无复发。结论肺毛霉病患者痰培养阳性率极低,病死率很高。对临床可疑病例应及时行纤维支气管镜检查,并经组织病理学确诊;治疗的关键在于早期诊断、控制基础病、应用大剂量的两性霉素 B 和及时的外科手术。
Objective To investigate the clinical manifestations, diagnosis and treatment of pulmonary mucormycosis. Methods Reported in 2006 in our hospital, confirmed by fiberoptic bronchoscopy and histopathology with complete data of 3 cases of pulmonary Mucura and combined with domestic and foreign literature review. Results 3 cases were farmers, 2 females, 1 males, aged 42 to 48 years. Cases 1 and 2 were patients with diabetic ketoacidosis, Case 1 died of massive hemoptysis on the next day of diagnosis; Case 2 was treated with a high dose of amphotericin B (total dose of 2 g); Case 3 was resection of squamous cell carcinoma of the right upper lobe Postoperative bronchoconstriction was successfully treated with high dose amphotericin B (total dose of 1.5 g) and bronchoscopic interventional therapy; cases 2 and 3 were followed up for 0.5 to 1 year without recurrence. Conclusion The positive rate of sputum culture in patients with pulmonary mucormycosis is very low, and the mortality rate is very high. Suspicious clinical cases should be promptly performed fiberoptic bronchoscopy, and confirmed by histopathology; treatment is the key to early diagnosis and control of underlying diseases, the application of large doses of amphotericin B and timely surgery.