Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Thorac Surg. 2014 Jan;97(1):218-23. doi: 10.1016/j.athoracsur.2013.08.010. Epub 2013 Oct 3.
A variety of complications occur in patients with pulmonary aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary aspergilloma have not been well evaluated.
The medical records of patients who underwent video-assisted thoracic surgery (VATS) or a thoracotomy for therapeutic resection of pulmonary aspergilloma between January 2005 and December 2012 were retrospectively reviewed for age, sex, indications for surgery, approach and procedures, postoperative pain, operative time, blood loss, hospital stay, cost, and complications.
A total of 310 patients underwent thoracotomy, 76 patients underwent attempted VATS lobectomy. Seventy-six patients from 310 patients for thoracotomy were selected and compared with the VATS group. Nine cases (11.8%) in the VATS group were converted to a thoracotomy for the following reasons: bleeding (n =2); dense fibrous adhesions (n =3); fused interlobar fissure (n =2); and hilar lymphadenopathy (n = 2). Lesions treated with pneumonectomy failed to be done using VATS. There was no difference in the blood loss and median operative time between the 2 groups, but the patients with VATS had shorter length of stay in the hospital (p = 0.035) and fewer complications (p = 0.032) than those with thoracotomy.
Video-assisted thoracic surgery is an alternative to open procedures in the management of pulmonary aspergilloma. Simple aspergilloma and complex aspergilloma without infiltration of the hilum are good candidates for VATS resection. Aspergilloma lesions that require a pneumonectomy are still a major challenge for VATS.
肺曲霉菌病患者会出现多种并发症。胸腔镜手术治疗肺曲霉菌病的安全性和可行性尚未得到很好的评估。
回顾性分析 2005 年 1 月至 2012 年 12 月期间接受电视辅助胸腔镜手术（VATS）或开胸手术治疗肺曲霉菌病的患者的病历，记录患者年龄、性别、手术适应证、手术方式和步骤、术后疼痛、手术时间、术中出血量、住院时间、费用和并发症等。
共 310 例患者接受了开胸手术，76 例患者接受了 VATS 肺叶切除术。从 310 例开胸手术患者中选择了 76 例并与 VATS 组进行比较。VATS 组中有 9 例（11.8%）患者转为开胸手术，原因如下：出血（n=2）；致密性纤维粘连（n=3）；叶间裂融合（n=2）；肺门淋巴结肿大（n=2）。VATS 无法完成全肺切除术。两组患者的术中出血量和中位手术时间无差异，但 VATS 组患者的住院时间较短（p=0.035），并发症较少（p=0.032）。
VATS 是治疗肺曲霉菌病的一种替代开放手术的方法。单纯性曲霉菌病和无肺门浸润的复杂性曲霉菌病是 VATS 切除的良好适应证。需要行全肺切除术的曲霉菌病病变仍然是 VATS 的一大挑战。
