Imura Y, Ohtsuka T, Kobayashi T
Department of Respiratory Surgery, Tokyo Metropolitan Fuchu Hospital, Japan.
Kekkaku. 1992 Feb;67(2):107-12.
Nine patients were diagnosed as suffering from localized pulmonary aspergillosis associated with restrictive ventilatory impairment. Eight cases reportedly received a combination of thoracoplasty and cavernoplasty, while one case received only cavernoplasty. The following postoperative courses were observed in these nine patients: of the eight patients having combined thoracoplasty and cavernoplasty, seven patients were cured as the result of successful cavity closures. Cavernotomy was required for the remaining patient whose cavity failed to close. An attempt was made to close the cavity of the one patient reported to have only cavernoplasty, but the cavity failed to close on the first attempt. The cavity was successfully closed in a later attempt using thoracoplasty. Although the application of thoracoplasty and cavernoplasty is useful and safe to the treatment of patients being unable to undergo resection and/or having pulmonary dysfunction, it is very important to reduce the number of ribs being resected because pulmonary function may be more worsened after operation. A combination of extraperiosteal detachment and cavernoplasty seems to be a useful alternative. A lower limitation of the postoperative ventilation function, evaluated as a ratio of FEV1.0/VCpr is thought to be 20%.
9例患者被诊断为局限性肺曲霉菌病合并限制性通气功能障碍。据报道，8例患者接受了胸廓成形术和空洞成形术联合治疗，1例仅接受了空洞成形术。观察了这9例患者的术后病程：在8例接受胸廓成形术和空洞成形术联合治疗的患者中，7例因空洞成功闭合而治愈。其余1例空洞未闭合的患者需要进行开胸手术。据报道，1例仅接受空洞成形术的患者尝试闭合空洞，但首次尝试未成功。后来采用胸廓成形术成功闭合了空洞。虽然胸廓成形术和空洞成形术对无法进行切除和/或有肺功能障碍的患者的治疗是有用且安全的，但减少切除肋骨的数量非常重要，因为术后肺功能可能会进一步恶化。骨膜外剥离和空洞成形术联合似乎是一种有用的替代方法。术后通气功能的下限，以FEV1.0/VCpr的比值评估，被认为是20%。
