Wu Zhi-yong, Su Qun, Zhou Yu-long, Ni Yi-ming, Ye Ding-sheng
Department of Cardiothoracic Surgery, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, China.
Zhonghua Wai Ke Za Zhi. 2004 May 22;42(10):614-6.
To summarize the experience of diagnosis and surgical treatment for pulmonary and pleural aspergillosis.
The clinical data of cases with pulmonary and pleural aspergillosis were analyzed retrospectively between September 1972 and June 2003. There were 53 cases with pulmonary aspergillosis and 3 cases with pleural aspergillosis. Aspergillus was found preoperatively in 8 patients by sputum culture (5 cases) or needle biopsy of the lung (2 cases) or fibro-bronchoscopic biopsy (1 case). All patients were treated with surgical procedures following X-ray film or CT scan.
Of 53 cases with pulmonary aspergillosis, 42 lobectomies, 3 segment-Pneumonectomies, and 8 wedge resections were performed. Of three cases with pleural aspergillosis following eliminating their diseased foci in residual pleural space, two underwent thoracoplasty, one underwent postoperative closed chest drainage for one and an half month with fluconazole injected into residual pleural space repeatedly for 1 month (200 mg/100 ml, 1 time per 2 or 3 days). No operative death and major postoperative complications occurred. None of the patients had recurrent symptoms at follow-up.
We recommend aggressive surgical resection for pulmonary and pleural aspergillosis, and the surgical result is excellent.
总结肺及胸膜曲霉菌病的诊断及外科治疗经验。
回顾性分析1972年9月至2003年6月间肺及胸膜曲霉菌病患者的临床资料。其中肺曲霉菌病53例,胸膜曲霉菌病3例。术前8例患者通过痰培养(5例)、肺穿刺活检(2例)或纤维支气管镜活检(1例)发现曲霉菌。所有患者均在X线片或CT扫描后接受手术治疗。
53例肺曲霉菌病患者中,行肺叶切除术42例,肺段-全肺切除术3例,楔形切除术8例。3例胸膜曲霉菌病患者在清除残留胸膜腔内病灶后,2例行胸廓成形术,1例行术后闭式胸腔引流1个半月,同时反复向残留胸膜腔内注入氟康唑1个月(200mg/100ml,每2或三天1次)。无手术死亡及严重术后并发症发生。随访期间所有患者均无复发症状。
我们建议对肺及胸膜曲霉菌病积极行手术切除,手术效果良好。