Mathisen D J, Grillo H C
General Thoracic Surgical Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Ann Thorac Surg. 1992 Dec;54(6):1053-7; discussion 1057-8. doi: 10.1016/0003-4975(92)90069-g.
We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2). Nine patients had severe stenosis of the trachea, carina, or main bronchus. Special stains identified Histoplasma capsulatum in surgical specimens in 9 patients. Surgical procedures were done for 18 of 20 patients (resection of subcarinal mass, 6; right middle and lower lobectomy, 5; carinal pneumonectomy, 4; esophagoplasty, 4; sleeve resection, 3 (with right main bronchus in 1, right lower and middle lobectomy in 1, and carina in 1); right upper lobectomy, 1; middle lobectomy, 1; and bronchoplasty of left main bronchus, 1. There were 4 deaths, 3 after complications of carinal pneumonectomy and 1 in a patient with tracheobronchial obstruction that could not be dilated. Two patients were treated with amphotericin and 4 with ketoconazole. Sclerosing mediastinitis secondary to histoplasmosis presents tremendous surgical challenges because of the intense fibrosis encountered. Bronchoplastic procedures are possible in spite of the intense fibrosis. High mortality rates after carinal resection may be encountered. The exact role of antifungal therapy is as yet undefined.
我们对20例被认为患有荚膜组织胞浆菌继发纵隔纤维化的患者进行了治疗。除1例患者外，其余均有症状。最常见的症状为呼吸困难（8例）、咯血（6例）、阻塞性肺炎（5例）和上腔静脉阻塞（2例）。9例患者存在气管、隆突或主支气管严重狭窄。特殊染色在9例患者的手术标本中发现了荚膜组织胞浆菌。20例患者中有18例接受了手术治疗（隆突下肿块切除术6例；右中下叶切除术5例；隆突全肺切除术4例；食管成形术4例；袖状切除术3例（其中1例为右主支气管，1例为右下中叶切除术，1例为隆突）；右上叶切除术1例；中叶切除术1例；左主支气管支气管成形术1例）。有4例死亡，3例死于隆突全肺切除术后并发症，1例死于气管支气管阻塞且无法扩张的患者。2例患者接受了两性霉素治疗，4例接受了酮康唑治疗。组织胞浆菌病继发的硬化性纵隔炎由于存在严重纤维化而带来巨大的手术挑战。尽管存在严重纤维化，支气管成形手术仍有可能。隆突切除术后可能会遇到高死亡率。抗真菌治疗的确切作用尚未明确。
