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肺癌手术后肺毁损合并肺曲霉菌病的空洞造口术:3例报告

Cavernostomy for Pulmonary Aspergillosis Associated with Destroyed Lung after Surgery for Lung Cancer: Report of 3 Cases.

作者信息

Takahashi Ryo, Fujiwara Taiki, Yamakawa Hisami

机构信息

Department of General Thoracic Surgery, National Hospital Organization Chiba-East Hospital, Chiba 260-0856, Japan ; Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-0801, Japan ; Department of Surgery, Jinken Clinic, Kanagawa 243-0432, Japan.

Department of General Thoracic Surgery, National Hospital Organization Chiba-East Hospital, Chiba 260-0856, Japan ; Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-0801, Japan.

出版信息

Case Rep Surg. 2015;2015:614795. doi: 10.1155/2015/614795. Epub 2015 Oct 20.

Abstract

Slow, progressive, and destructive changes in the residual lung after surgery for lung cancer, known as "destroyed lung," are delayed nonrecurrent complications. Destroyed lung can be a difficult condition to treat due to repeated infections and is therefore a complication that should not be ignored. We had three cases of intractable pulmonary aspergillosis difficult to treat associated with destroyed lung, after lung cancer surgery. Two of these patients followed a characteristic clinical course, which started with a cystic change just below the pleura and subsequently led to respiratory failure and death due to repeated infections. The third patient followed a similar clinical course and is currently under regular follow-up. Our cases suggest that concomitant occurrence of severe complications following surgery for lung cancer, such as destroyed lung and pulmonary aspergillosis, should be monitored because these complications can lead to respiratory failure and fatal clinical course. Radical surgery is not possible, especially when medical treatment is ineffective in controlling repeated infections and the patient's general condition is worsened due to prolonged chronic inflammation. Therefore, aggressive surgical intervention should be considered before patients worsen.

摘要

肺癌手术后残肺出现的缓慢、进行性和破坏性变化,即所谓的“毁损肺”,属于延迟性非复发性并发症。由于反复感染,毁损肺可能是一种难以治疗的病症,因此是一种不应被忽视的并发症。我们有3例肺癌手术后与毁损肺相关的难治性肺曲霉病病例。其中2例患者呈现出典型的临床病程,始于胸膜下方的囊性改变,随后因反复感染导致呼吸衰竭和死亡。第3例患者有类似的临床病程,目前正在接受定期随访。我们的病例表明,肺癌手术后应监测严重并发症如毁损肺和肺曲霉病的同时发生情况,因为这些并发症可能导致呼吸衰竭和致命的临床病程。尤其是当药物治疗无法有效控制反复感染且患者的一般状况因长期慢性炎症而恶化时,根治性手术是不可能的。因此,应在患者病情恶化之前考虑积极的手术干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5276/4630383/29cbb0d7de03/CRIS2015-614795.001.jpg

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