Cesaro Simone, Cecchetto Giovanni, De Corti Federica, Dodero Paolo, Giacchino Mareva, Caviglia Ilaria, Fagioli Franca, Livadiotti Susanna, Salin Federica, Caselli Desireè, Castagnola Elio
Clinic of Pediatric Hematology Oncology, Department of Pediatrics, University of Padua, Padua, Italy.
Pediatr Blood Cancer. 2007 Dec;49(7):909-13. doi: 10.1002/pbc.21089.
Invasive aspergillosis (IA) is a serious problem in patients suffering from hematological malignancies. Surgical resection has been reported to improve disease control and patient survival. There are few reports describing the role of surgery in children with pulmonary IA.
From October 1998 to September 2005, 21 patients fulfilled the inclusion criteria. Demographic and clinical data, as well as type and duration of antifungal therapy; surgery and related complications; time elapsing from surgery to resumption of chemotherapy were collected retrospectively through a specially designed form filled in by each investigator.
Eleven males and 10 females, aged between 2 and 17 years underwent one or more surgical lung resections for diagnostic and therapeutic purposes. Surgical complications were reported in three patients. Two patients, who underwent a wedge resection and a lobectomy, respectively, had no fungal lesions detected at surgery. Seventeen of 20 patients with malignancy resumed chemotherapy after a median of 19 days from surgery, range 7-81, and 11 of them underwent hematopoietic stem cell transplantation after a median time of 60 days from surgery, range 19-110. After a median follow-up of 1.7 years, 12 patients are alive while 9 patients have died from progression of their underlying disease.
This study suggests that the combination of medical antifungal therapy and early surgical excision is a feasible and an effective strategy in pediatric patients with IA. In order to avoid unnecessary surgical procedures, we advise checking the response to antifungal therapy by chest-computed tomography immediately before the date of surgery.
侵袭性曲霉病（IA）在血液系统恶性肿瘤患者中是一个严重问题。据报道，手术切除可改善疾病控制及患者生存率。关于手术在儿童肺IA中的作用，报道较少。
1998年10月至2005年9月，21例患者符合纳入标准。通过各研究者填写的专门设计表格，回顾性收集人口统计学和临床数据，以及抗真菌治疗的类型和持续时间、手术及相关并发症、从手术到恢复化疗的时间。
11例男性和10例女性，年龄在2至17岁之间，为诊断和治疗目的接受了一次或多次肺手术切除。3例患者报告有手术并发症。分别接受楔形切除术和肺叶切除术的2例患者，手术时未发现真菌病灶。20例恶性肿瘤患者中，17例在手术后中位19天（范围7 - 81天）恢复化疗，其中11例在手术后中位60天（范围19 - 110天）接受了造血干细胞移植。中位随访1.7年后，12例患者存活，9例患者死于基础疾病进展。
本研究表明，抗真菌药物治疗与早期手术切除相结合，对儿童IA患者是一种可行且有效的策略。为避免不必要的手术操作，我们建议在手术前立即通过胸部计算机断层扫描检查抗真菌治疗的反应。
