Ueda H, Okabayashi K, Ondo K, Motohiro A
Department of Surgery, National Minamifukuoka Chest Hospital, Fukuoka, Japan.
Surg Today. 2001;31(9):768-73. doi: 10.1007/s005950170045.
The objective of this study was to analyze the results of various treatments for pulmonary aspergilloma and to determine the surgical indications. A total of 41 patients with pulmonary aspergilloma hospitalized at the National Minamifukuoka Chest Hospital between 1973 and 1999 were analyzed with regard to their response to treatment and long-term prognosis. Five asymptomatic patients who were untreated demonstrated no change in the clinical status of aspergilloma. Analysis of the short-term response revealed surgery to be the most effective treatment. Systemic and intracavitary injections of antifungal drugs were not definitely effective, although they had a positive effect in some patients. A survival analysis revealed that all eight patients who underwent surgery are still alive. Using the Cox proportional hazard model, it was found that the favorable prognostic factors were the absence of symptoms, the absence of a superimposed bacterial infection, and surgery. There were ten deaths: three from lung cancer and seven related to uncontrollable superimposed bacterial infections, often resulting in hemoptysis. We conclude that patients with asymptomatic pulmonary aspergillomas should be clinically observed for signs of the development of lung cancer, but do not require active treatment. On the other hand, patients who are symptomatic and have uncontrollable superimposed bacterial infection will benefit from surgery.
本研究的目的是分析肺曲菌球的各种治疗结果并确定手术指征。对1973年至1999年间在国立南福冈胸科医院住院的41例肺曲菌球患者的治疗反应和长期预后进行了分析。5例未经治疗的无症状患者，曲菌球的临床状况无变化。短期反应分析显示手术是最有效的治疗方法。全身和腔内注射抗真菌药物虽对部分患者有积极作用，但效果不确切。生存分析显示，接受手术的8例患者均存活。使用Cox比例风险模型发现，良好的预后因素是无症状、无叠加细菌感染和手术。有10例死亡：3例死于肺癌，7例与无法控制的叠加细菌感染有关，常导致咯血。我们得出结论，无症状肺曲菌球患者应临床观察是否有肺癌发生迹象，但无需积极治疗。另一方面，有症状且有无法控制的叠加细菌感染的患者将从手术中获益。
