a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China.
b Department of Oncology , Second People Hospital of Dezhou , Dezhou, Shandong Province , China.
Int J Hyperthermia. 2018;35(1):71-78. doi: 10.1080/02656736.2018.1476738. Epub 2018 Jun 6.
Invasive pulmonary aspergillosis (IPA) is a life-threatening complication of microwave ablation (MWA) during the treatment of primary or metastatic lung tumors. The purpose of this study was to investigate the clinical, radiological and demographic characteristics and treatment responses of patients with IPA after MWA.
From January 2011 to January 2016, all patients who were treated by MWA of their lung tumors from six health institutions were enrolled in this study. Patients with IPA secondary to MWA were identified and retrospectively evaluated for predisposing factors, clinical treatment, and outcome.
The incidence of IPA secondary to lung MWA was 1.44% (23/1596). Of the 23 patients who developed IPA, six died as a consequence, resulting in a high mortality rate of 26.1%. Using computed tomography (CT), pulmonary cavitation was the most common finding and occurred in 87.0% (20/23) of the patients. Sudden massive hemoptysis was responsible for one-third of the deaths (2/6). Most patients (22/23) received voriconazole as an initial treatment, and six patients with huge cavities underwent intracavitary lavage. Finally, 17 patients (73.9%) achieved treatment success.
Lung MWA may be an additional host risk factor for IPA, particularly in elderly patients with underlying diseases and in patients who have recently undergone chemotherapy. Early and accurate diagnosis of IPA after MWA is critical for patient prognosis. Voriconazole should be given as the first-line treatment as early as possible. Bronchial artery embolization or intracavitary lavage may be required in some patients.
侵袭性肺曲霉病（IPA）是微波消融（MWA）治疗原发性或转移性肺部肿瘤过程中危及生命的并发症。本研究旨在探讨 MWA 后 IPA 患者的临床、影像学和人口统计学特征及治疗反应。
2011 年 1 月至 2016 年 1 月，来自 6 家医疗机构的 1596 例行 MWA 治疗肺部肿瘤的患者纳入本研究。对因 MWA 导致 IPA 的患者进行回顾性评估，分析其易患因素、临床治疗及结局。
肺 MWA 后 IPA 的发生率为 1.44%（23/1596）。23 例 IPA 患者中 6 例死亡，死亡率高达 26.1%。23 例患者中，胸部 CT 最常见的表现是肺空洞，占 87.0%（20/23）。1/3 的死亡病例由突发大咯血所致（2/6）。大多数患者（22/23）接受伏立康唑作为初始治疗，6 例大空洞患者接受了腔内灌洗。最终，17 例（73.9%）患者治疗成功。
肺部 MWA 可能是 IPA 的宿主附加危险因素，尤其在患有基础疾病的老年患者和近期接受过化疗的患者中。早期准确诊断 MWA 后 IPA 对患者预后至关重要。应尽早给予伏立康唑作为一线治疗。对于部分患者可能需要支气管动脉栓塞或腔内灌洗。
