Hammoud Zane T, Rose Anthony S, Hage Chadi A, Knox Kenneth S, Rieger Karen, Kesler Kenneth A
Department of Surgery, Division of Cardiothoracic Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Ann Thorac Surg. 2009 Aug;88(2):399-403. doi: 10.1016/j.athoracsur.2009.04.041.
Histoplasmosis may result in a spectrum of complications that require thoracic surgical intervention. We reviewed our 17-year experience in the management of histoplasmosis to determine outcomes as well as gain insight into the distribution of complications requiring surgical intervention.
The hospital records of patients who underwent surgical treatment for complications related to histoplasmosis from 1991 to 2008 were reviewed. Based on the predominant presentation, patients were categorized with complications secondary to broncholithiasis, granulomatous disease, or fibrosing mediastinitis. Patients who underwent diagnostic surgery and were found to have histoplasmosis were excluded.
Of the 49 patients who underwent surgery for histoplasmosis-related complications, 27 (55%) had granulomatous disease, 13 (27%) had broncholithiasis, and 9 (18%) had fibrosing mediastinitis. The most common clinical presentations were recurrent pneumonia (n = 16) and hemoptysis (n = 13); less common presentations included dysphagia (n = 3) and superior vena cava syndrome (n = 1). Two patients required cardiopulmonary bypass for resection; 1 of these died postoperatively (series mortality 2%). Seven patients (14%) had complications. Relief of symptoms was achieved in all surviving patients.
Complications of histoplasmosis requiring thoracic surgical intervention are diverse with pulmonary complications predominating. Although surgically challenging, excellent short- and long-term outcomes may be expected.
组织胞浆菌病可能导致一系列需要胸外科手术干预的并发症。我们回顾了我们在组织胞浆菌病管理方面17年的经验，以确定治疗结果，并深入了解需要手术干预的并发症分布情况。
回顾了1991年至2008年因组织胞浆菌病相关并发症接受手术治疗的患者的医院记录。根据主要表现，患者被归类为继发于支气管结石症、肉芽肿性疾病或纤维性纵隔炎的并发症。接受诊断性手术并被发现患有组织胞浆菌病的患者被排除在外。
在49例因组织胞浆菌病相关并发症接受手术的患者中，27例（55%）患有肉芽肿性疾病，13例（27%）患有支气管结石症，9例（18%）患有纤维性纵隔炎。最常见的临床表现是反复肺炎（n = 16）和咯血（n = 13）；较少见的表现包括吞咽困难（n = 3）和上腔静脉综合征（n = 1）。两名患者切除手术需要体外循环；其中1例术后死亡（系列死亡率2%）。7例患者（14%）出现并发症。所有存活患者的症状均得到缓解。
需要胸外科手术干预的组织胞浆菌病并发症多种多样，以肺部并发症为主。尽管手术具有挑战性，但预期可获得良好的短期和长期结果。
