Xie Dong, Chen Xiao-feng, Jiang Ge-ning, Xu Zhi-fei, You Xiao-fang, Chen Chang, Zhou Xiao, Ding Jia-an
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
Zhonghua Wai Ke Za Zhi. 2012 May;50(5):430-3.
To clarify the clinical feature, diagnosis and therapy of the pulmonary cryptococcosis (PC).
A retrospective study of cases with PC who were diagnosed by pathological examinations between January 1996 and December 2010 was conducted. Eighty-one cases were enrolled in the study (58 male and 23 female patients; mean age of (51±11) years). Forty-one cases were asymptomatic at the time of diagnosis. There were single pulmonary lesions in 50 cases, and multiple lesions in 31 cases. Fourteen lesions (17.3%) were located in left upper lobe, 27 (33.3%) in left lower lobe, 21 (25.9%) in right upper lobe, 3 (3.7%) in right middle lobe, 28 (34.6%) in right lower lobe, and 3 (3.7%) diffusely involved bilateral lungs. The tumors ranged from 0.8 to 10.0 cm in diameter with a mean of (2.9±1.8) cm. All the cases were misdiagnosis prior to the surgical resection, and histologically confirmed by postoperative pathological specimens.
All the cases received surgical treatment including complete resection in 69 cases, and palliative resection in 12 cases. Resections were performed by means of video-assisted thoracoscopy in 31 cases and thoracotomy in 50 cases. Surgical resections included pulmonary wedge excisions in 42 cases, and lobectomies in 39 cases. After histological confirmation, 63 cases (77.8%) were treated with antifungal agents, which consisted of fluconazole in 38 cases, itraconazole in 18 cases, amphotericin B in 6 cases, and flucytosine in 4 cases. There were no intraoperative death, but two cases died for cryptococcal meningoencephalitis in the postoperative period. Operative morbidity occurred in 7 (8.6%) cases. The median follow-up was 42.5 months (6 to 84 months). There were 2 local relapses of PC, and 9 cases with complications of anti-fungal agents.
The clinical manifestations of PC are mild and non-specific, with no characteristic radiographic manifestations. Surgical resection is usually indicated for definite diagnosis and treatment. Antifungal drug therapy is indispensable even after complete resection.
阐明肺隐球菌病（PC）的临床特征、诊断及治疗方法。
对1996年1月至2010年12月间经病理检查确诊为PC的病例进行回顾性研究。纳入研究的病例共81例（男性58例，女性23例；平均年龄(51±11)岁）。41例在诊断时无症状。50例为单发病灶，31例为多发病灶。14个病灶（17.3%）位于左上叶，27个（33.3%）位于左下叶，21个（25.9%）位于右上叶，3个（3.7%）位于右中叶，28个（34.6%）位于右下叶，3个（3.7%）双侧肺弥漫性受累。肿瘤直径0.8至10.0 cm，平均(2.9±1.8) cm。所有病例在手术切除前均被误诊，术后病理标本经组织学确诊。
所有病例均接受了手术治疗，其中69例行根治性切除，12例行姑息性切除。31例采用电视辅助胸腔镜手术，50例采用开胸手术。手术切除包括42例肺楔形切除术和39例肺叶切除术。组织学确诊后，63例（77.8%）接受了抗真菌药物治疗，其中38例使用氟康唑，18例使用伊曲康唑，6例使用两性霉素B，4例使用氟胞嘧啶。术中无死亡病例，但术后有2例死于隐球菌性脑膜脑炎。7例（8.6%）发生手术并发症。中位随访时间为42.5个月（6至84个月）。PC局部复发2例，抗真菌药物并发症9例。
PC的临床表现轻微且无特异性，无特征性影像学表现。手术切除通常用于明确诊断和治疗。即使在根治性切除后，抗真菌药物治疗也是必不可少的。
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