What disease is lung abscess? Is it cancer? Can it be cured?

Pulmonary abscess is a purulent cavitary lesion of the lung. Most acute lung abscess can be cured by drug treatment, but if the treatment is not timely and thorough, it can turn into chronic lung abscess, which needs surgical treatment.

Etiology Pathology The occurrence and development of lung abscess often have the following three factors: ① bacterial infection; ② Bronchial obstruction; (3) The systemic resistance is decreased. There are two common causes in clinic: blood-borne infection and tracheal infection. Blood-borne infections are mainly caused by septicemia and sepsis, with extensive lesions, often multiple, and are mainly treated with drugs. Tracheal infection mainly comes from secretions with bacteria in respiratory tract or upper digestive tract. After sleep, coma, drunkenness, anesthesia or epilepsy, and cerebrovascular accident, it is inhaled into trachea and lungs, causing bronchial obstruction and inducing lung abscess when the human body's resistance decreases.

Pulmonary atelectasis and inflammation occur in the distal lung segment of bronchial obstruction, which leads to necrosis and liquefaction of lung tissue, inflammatory reaction of surrounding pleura and lung tissue, and finally forms a certain range of abscess. After the abscess was formed, it gradually turned into a chronic phase after acute and subacute stages such as poor bronchial drainage and incomplete infection control. In the process of repeated attacks and staggered evolution of infection, the affected lungs and bronchi have both destruction and tissue repair; There are both lung tissue lesions and bronchopleural lesions; Both acute inflammation; Have chronic inflammation; The main manifestations are pus cavity in lung tissue, different degrees of interstitial inflammation and fibrosis around it, and different degrees of obstruction and dilatation of related bronchi.

Chronic lung abscess has the following three characteristics: ① At the beginning, the abscess site mostly resides in the superficial part of the lung segment or lobe; ② The pus cavity is always communicated with one or more bronchioles; ③ Abscess spreads outward, but it is not limited by the boundaries of lung segments and lobes in the late stage, and can form destructive lesions across lung segments and lobes, with multiple interconnected cavities.

When the body's resistance is poor, the lesion develops rapidly, and the pleural adhesion is not firm, the abscess can puncture the lung pleura to produce acute tension empyema, accompanied by bronchopleural fistula.

Due to pleural adhesion, chronic lung abscess forms collateral circulation, and the blood flow direction is from chest wall systemic circulation with high blood pressure to pulmonary circulation with low blood pressure. Clinically, persistent vascular murmur aggravated by contraction can be heard on its body surface. Anyone who has this murmur has a large amount of bleeding during operation, and should be fully prepared for blood supplement and hemostasis. Patients with chronic lung abscess have long-term cough, hemoptysis, purulent sputum, symptoms of systemic poisoning, poor nutritional status, impaired respiratory function, anemia, emaciation, edema, clubbed fingers, etc.

The symptoms and diagnosis of lung abscess are acute, often accompanied by upper respiratory tract infection, pneumonia, bronchitis and oral lesions. Initial symptoms include chills, fever, general malaise, chest pain and dry cough. After drug treatment, the acute symptoms improved, but not completely eliminated, and gradually turned into chronic lung abscess. The main symptoms are cough, expectoration, hemoptysis, intermittent fever and chest pain. Its expectoration is large, sticky, purulent and smelly.

Physical examination showed lung dullness, auscultation of various rales and tubular breathing sounds, and a few cases could hear pleural adhesion vascular murmurs. People with a long course of disease often have clubbed fingers.

Besides analyzing the history, symptoms and physical examination, X-ray examination is necessary for diagnosis. Chest plain film shows lung cavity lesions with thick wall and often gas level, surrounded by infiltration and cord-like shadows, accompanied by pleural thickening. Bronchography is very helpful for the presence or absence of bronchiectasis and the scope of lesion resection. Those who choke due to eating should be examined by iodine oil or barium meal esophagography to determine whether there is esophagotracheal fistula; If it needs to be differentiated from lung cancer, bronchoscopy is needed.

Those who treat lung abscess within three months should be treated with systemic and drug therapy. Including systemic application of antibiotics, postural drainage, local drip, spray and sputum aspiration through bronchoscope. If the above treatment fails, consider surgical treatment.

Surgical indications:

1. The course of disease is more than three months, and the disease is not obviously absorbed after drug treatment, and there are more symptoms after persistent or repeated attacks.

2. Chronic lung abscess has the threat of sudden massive hemoptysis to death, or massive hemoptysis does not stop after active drug treatment, and should be rescued by surgery in time.

3. If the infection of chronic lung abscess is difficult to control due to bronchial obstruction, pneumonectomy should be performed after proper preparation.

4. Chronic lung abscess coexists with other pathological changes, or cannot be completely differentiated, such as tuberculosis, lung cancer, pulmonary fungal infection, etc. , but also need lung resection.

Preoperative preparation: including improving patients' general condition, strengthening nutrition, intermittent blood transfusion, systemic use of antibiotics, postural expectoration, local spraying and intratracheal instillation. After 3 ~ 6 weeks of hospitalization preparation, the amount of sputum decreased to less than 50ml per day; Phlegm changed from thick yellow pus to white and sticky; Both appetite and weight have increased; Hemoglobin is close to normal, temperature and pulse tend to be stable, and surgery can be performed.

Scope of operation: the operation of lung abscess is difficult, with much bleeding, and the lesion often spans the lung lobe. The operating range should not be too conservative. As far as possible, segmental or partial lobectomy is not required, but most of them are beyond the scope of lobectomy and even require pneumonectomy.

Surgical complications: hemorrhagic shock, bronchial fistula and empyema, aspiration pneumonia and esophageal fistula are common.

Its prognosis, most chronic lung abscess after surgical treatment, the curative effect is satisfactory, the symptoms disappear, and return to normal work.