Pagès P-B, Grima R, Mordant P, Grand B, Badia A, Le Pimpec-Barthes F, Bernard A, Riquet M
Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France; Service de chirurgie thoracique et cardiovasculaire, CHU Bocage, université de Bourgogne, 21000 Dijon, France.
Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France.
Rev Pneumol Clin. 2014 Dec;70(6):322-8. doi: 10.1016/j.pneumo.2014.08.002. Epub 2014 Nov 20.
Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma.
The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2.
Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P = 0.30). Univariable analysis showed that immunocompromised status (P < 0.001), past history of cancer (P = 0.50), preoperative purulent sputum (P = 0.024), and pneumonectomy (P < 0.001) were significantly associated with postoperative complications, but that antifungal therapy was not. Five- and 10-year overall survival rates were respectively 78.3% and 57.8% in group 1 vs. 85.9% and 65.7% in group 2 (P = 0.23). Multivariate analysis revealed that age higher than 50, immunocompromised status and pneumonectomy were significantly associated with adverse long-term survival (χ(2) = 6.59, df = 5, P < 0.001), but that antifungal therapy was not.
Antifungal therapy has no significant impact on postoperative morbidity or long-term survival following surgical resection of pulmonary aspergilloma. Such procedure is associated with acceptable postoperative morbidity and long-term survival.
鉴于肺曲菌球病局限且患者身体状况足以承受手术，手术切除肺曲菌球可控制症状、预防并发症并提高生存率。在这些可手术治疗的病例中，围手术期抗真菌治疗的影响仍存在争议。本研究旨在分析抗真菌治疗对可手术治疗的肺曲菌球患者术后发病率和总生存率的影响。
回顾性分析1989年1月至2010年12月在我院接受胸外科手术治疗曲菌球的113例患者的临床记录。其中，64例患者在围手术期接受了抗真菌治疗，纳入第1组；49例患者未接受抗真菌治疗，纳入第2组。
第1组术后并发症发生率为31.2%，第2组为20.4%（P = 0.30）。单因素分析显示，免疫功能低下状态（P < 0.001）、既往癌症史（P = 0.50）、术前脓性痰（P = 0.024）和肺切除术（P < 0.001）与术后并发症显著相关，但抗真菌治疗与术后并发症无关。第1组的5年和l0年总生存率分别为78.3%和57.8%，第2组分别为85.9%和65.7%（P = 0.23）。多因素分析显示，年龄大于50岁、免疫功能低下状态和肺切除术与长期生存不良显著相关（χ(2)=6.59，自由度=5，P < 0.001），但抗真菌治疗与长期生存不良无关。
抗真菌治疗对肺曲菌球手术切除后的术后发病率或长期生存无显著影响。该手术术后发病率和长期生存率均可接受。
