Theodore Sanjay, Liava'a Matthew, Antippa Phillip, Wynne Rochelle, Grigg Andrew, Slavin Monica, Tatoulis James
Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Ann Thorac Surg. 2009 May;87(5):1532-8. doi: 10.1016/j.athoracsur.2009.02.069.
The purpose of this study was to analyze our institutional results with pulmonary resection in neutropenic patients with hematologic malignancies and suspected invasive pulmonary fungal infections.
We performed a retrospective medical record review of 25 immunocompromised patients with hematologic malignancies who underwent pulmonary resection between 2000 and 2007. We analyzed preoperative diagnostic technique, degree of pulmonary resection, and postoperative morbidity and mortality to determine whether surgery is a viable treatment option in this subset of patients.
Twenty-three of 25 patients had a minithoracotomy compared with 2 who had video-assisted thorascopic surgery resection only. Thirteen had wedge resections, 9 had lobectomies, and 3 had segmentectomies. Early surgical morbidity was 2 of 25, involving 1 pneumothorax and 1 empyema. In-hospital mortality was 2, with 1 death primarily related to surgery. Median survival was 342 days, and survival was significantly better in patients with only one lesion. No patient experienced late recurrence of invasive pulmonary fungal infection. Resected pulmonary tissue also provided the best chance for a proven diagnosis in 19 of 25 (76%).
This study confirms that pulmonary resection in high-risk immunocompromised patients with suspected invasive fungal infection can be carried out with excellent operative morbidity and mortality.
本研究的目的是分析我院对血液系统恶性肿瘤合并疑似侵袭性肺部真菌感染的中性粒细胞减少患者进行肺切除的结果。
我们对2000年至2007年间接受肺切除的25例免疫功能低下的血液系统恶性肿瘤患者的病历进行了回顾性研究。我们分析了术前诊断技术、肺切除程度以及术后发病率和死亡率，以确定手术是否是这部分患者可行的治疗选择。
25例患者中，23例行微创开胸手术，2例仅行电视辅助胸腔镜手术切除。13例行楔形切除术，9例行肺叶切除术，3例行肺段切除术。早期手术并发症为25例中的2例，包括1例气胸和1例脓胸。住院死亡率为2例，1例死亡主要与手术有关。中位生存期为342天，仅1个病灶的患者生存期明显更长。没有患者发生侵袭性肺部真菌感染的晚期复发。切除的肺组织也为25例中的19例（76%）提供了确诊的最佳机会。
本研究证实，对疑似侵袭性真菌感染的高危免疫功能低下患者进行肺切除，手术发病率和死亡率可控制在良好水平。
