Cesar Jorge Ms, Resende Jose S, Amaral Nilson F, Alves Carla Ms, Vilhena Alyne F, Silva Frederico L
Department of Thoracic Surgery, Júlia Kubitschek Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazi.
J Cardiothorac Surg. 2011 Oct 5;6:129. doi: 10.1186/1749-8090-6-129.
The most adequate surgical technique for the treatment of pulmonary aspergilloma is still controversial. This study compared two groups of patients submitted to cavernostomy and pulmonary parenchyma resection.
Cases of pulmonary aspergilloma operated upon between 1979 and 2010 were analyzed retrospectively. Group 1 consisted of patients submitted to cavernostomy and group 2 of patients submitted to pulmonary parenchyma resection. The following variables were compared between groups: gender, age, number of hospitalizations, pre- and postoperative length of hospital stay, time of follow-up, location and type of aspergilloma, preoperative symptoms, underlying disease, type of fungus, preoperative pulmonary function, postoperative complications, patient progression, and associated diseases.
A total of 208 patients with pulmonary aspergilloma were studied (111 in group 1 and 97 in group 2). Group 1 was older than group 2. The number of hospitalizations, length of hospital stay and time of follow-up were higher in group 1. Hemoptysis was the most frequent preoperative symptom in group 1. Preoperative respiratory malfunction was more severe in group 1. Hemorrhagic complications and recurrence were more frequent in group 1 and infectious complications and residual pleural space were more common in group 2. Postoperative dyspnea was more frequent in group 2. Patient progression was similar in the two groups. No difference in the other factors was observed between groups.
Older patients with severe preoperative respiratory malfunction and peripheral pulmonary aspergilloma should be submitted to cavernostomy. The remaining patients can be treated by pulmonary resection.
治疗肺曲霉球最恰当的手术技术仍存在争议。本研究比较了两组接受空洞造口术和肺实质切除术的患者。
回顾性分析1979年至2010年间接受手术治疗的肺曲霉球病例。第1组由接受空洞造口术的患者组成，第2组由接受肺实质切除术的患者组成。比较两组之间的以下变量：性别、年龄、住院次数、术前和术后住院时间、随访时间、曲霉球的位置和类型、术前症状、基础疾病、真菌类型、术前肺功能、术后并发症、患者病情进展及相关疾病。
共研究了208例肺曲霉球患者（第1组111例，第2组97例）。第1组患者年龄比第2组大。第1组的住院次数、住院时间和随访时间更长。咯血是第1组最常见的术前症状。第1组术前呼吸功能障碍更严重。第1组出血并发症和复发更频繁，第2组感染并发症和残留胸腔更常见。第2组术后呼吸困难更频繁。两组患者病情进展相似。两组之间在其他因素方面未观察到差异。
术前呼吸功能严重障碍且患有周围型肺曲霉球的老年患者应接受空洞造口术。其余患者可采用肺切除术治疗。
