Mun M, Kohno T, Yamada S
Department of Thoracic Surgery, Toranomon Hospital, Tokyo, Japan.
Kyobu Geka. 2002 Jul;55(7):544-8.
A 70-year-old man was admitted to our hospital because of hemoptysis and abnormal shadows on chest film. He was given a diagnosis of pulmonary aspergilloma with fungus ball by computed tomography and other evaluations. Success rate of systemic or topical treatment with antifungal agents is reported to be 80%. At this case lobectomy under VATS was chosen because he had chronic liver dysfunction by hepatitis type C and the lesion was localized in the right upper lobe. Bronchial artery embolization was performed prior to the operation in order to minimise bleeding on lysing the adhesion between the chest wall and the lobe with aspergilloma. Operation was underwent safety with a bloodloss of 170 ml. Success rate of operation is reported to be 95.8% in pulmonary resection. If bronchial artery embolization is successful and the lesion is localized, lobectomy under VATS can be good option in selected patients.
一名70岁男性因咯血及胸部X光片出现异常阴影入院。经计算机断层扫描及其他评估,他被诊断为肺曲菌球型肺曲霉菌病。据报道,抗真菌药物全身或局部治疗的成功率为80%。此病例因患有丙型肝炎导致慢性肝功能不全且病变局限于右上叶,故而选择在电视辅助胸腔镜手术(VATS)下行肺叶切除术。术前进行了支气管动脉栓塞术,以尽量减少在松解胸壁与曲霉菌瘤所在肺叶之间粘连时的出血。手术顺利,出血量为170毫升。据报道,肺切除术的手术成功率为95.8%。如果支气管动脉栓塞成功且病变局限,对于选定的患者,VATS下肺叶切除术可能是一个不错的选择。