背景:肉芽肿的组织学诊断通常被认为在临床上等同于在流行地区明确诊断肺结核(TB)。肺部手术切除肉芽肿性炎症的最佳治疗,分枝杆菌培养结果为阴性,然而,尚不清楚。
方法:来自北方的7家医疗机构,中间,在2010年1月至2018年12月期间,我们对手术切除的肺结节具有提示TB的组织学特征但微生物学研究结果阴性且未接受后续抗结核治疗的患者进行了回顾性鉴定.所有患者均随访2年,直到诊断出死亡或活动性结核病。
结果:研究期间共纳入116例患者。其中,61例患者(52.6%)临床无症状,36例(31.0%)患者免疫功能低下。孤立性肺结节占全部病例的44例(39.6%)。肺结节经楔形切除95例(81.9%),肺叶切除术17例(14.7%),4例(3.4%)患者进行了段切除术。最常见的组织学特征是肉芽肿性炎症(n=116[100%]),其次是干酪样坏死(n=39[33.6%])。在随访期间(218.4患者年),所有患者均未出现活动性结核病.
结论:在手术切除培养阴性的肺肉芽肿患者中,后续活动性TB的发病率较低。观察监测以及定期临床,放射学,和微生物随访,而不是常规的抗结核治疗,也可能是一个合理的选择。
BACKGROUND: Histologic diagnosis of granuloma is often considered clinically equivalent to a definite diagnosis of pulmonary tuberculosis (TB) in endemic areas. Optimal management of surgically resected granulomatous inflammation in lung with negative mycobacterial culture results, however, remains unclear.
METHODS: From 7 medical institutions in northern, middle, and southern Taiwan between January 2010 and December 2018, patients whose surgically resected pulmonary nodule(s) had histological features suggestive of TB but negative microbiological study results and who received no subsequent anti-TB treatment were identified retrospectively. All patients were followed up for 2 years until death or active TB disease was diagnosed.
RESULTS: A total of 116 patients were enrolled during the study period. Among them, 61 patients (52.6%) were clinically asymptomatic, and 36 (31.0%) patients were immunocompromised. Solitary pulmonary nodule accounted for 44 (39.6%) of all cases. The lung nodules were removed by wedge resection in 95 (81.9%), lobectomy in 17 (14.7%), and segmentectomy in 4 (3.4%) patients. The most common histological feature was granulomatous inflammation (n=116 [100%]), followed by caseous necrosis (n=39 [33.6%]). During follow-up (218.4 patient-years), none of the patients developed active TB.
CONCLUSIONS: In patients with surgically resected culture-negative pulmonary granulomas, the incidence rate of subsequent active TB is low. Watchful monitoring along with regular clinical, radiological, and microbiological follow-up, instead of routine anti-TB treatment, may also be a reasonable option.