小儿肺部曲霉菌病的外科治疗。

Surgical management of pulmonary aspergillosis in pediatric population.

出版信息

J Pediatr Surg. 2019 Sep;54(9):1938-1940. doi: 10.1016/j.jpedsurg.2019.01.003. Epub 2019 Jan 11.

DOI:10.1016/j.jpedsurg.2019.01.003

Abstract

INTRODUCTION

Aspergillosis is an invasive infection that affects mainly immunocompromised patients, and the lung is the most common site of infection. We reviewed our experience with the surgical management of pulmonary aspergillosis (PA) in pediatric population at a tertiary care institution.

METHODS

A retrospective chart review was conducted for pediatric patients (<16 years) who were managed for PA over the period from January 2001 to December 2016. Demographic, clinical, and outcome data were retrieved, and descriptive data were generated.

RESULTS

Eighty patients had microbiologically-proven PA over the period of the study, and 38 of them (48%) had a surgical intervention during their management. Among the surgical group, there were 19 males and 19 females with a mean age of 9.4 years (0.5-16). Thirty-five patients (92%) were in an immunocompromised state (10 of them have had bone marrow transplant), 2 patients had cystic lung disease, and 1 had scleroderma. All had fever and respiratory symptoms at presentation and received systemic antifungal medications. All had Computerized tomography (CT) scan examinations which showed features suggestive of the disease. Surgical procedures included lung biopsy in 13 patients (34%), segmentectomy in 12 patients (32%), lobectomy in 8 patients (21%), debridement/cavernostomy in 3 patients (8%), and 2 patients had pneumonectomy (5%). Histopathological examination revealed invasive fungal infection in 20 patients (53%) and aspergilloma in 18 (47%). Eleven patients (29%) died owing to a combination of fungal infection and the underlying disease. Three other patients, not included in the surgical series, died secondary to severe pulmonary hemorrhage while waiting for surgery. All had cavitation on CT scan near the hilum of the lung.

CONCLUSIONS

Pulmonary aspergillosis is a severe invasive infection with a significant mortality. Early surgical intervention is recommended in patients who do not improve on antifungal medication, especially in those with cavitating lesions, in order to improve outcome.

TYPE OF STUDY

Case series.

LEVEL OF EVIDENCE

IV.

摘要

介绍

曲霉菌病是一种侵袭性感染，主要影响免疫功能低下的患者，肺部是最常见的感染部位。我们回顾了在一家三级医疗机构中对儿科人群肺部曲霉菌病（PA）进行手术治疗的经验。

方法

对 2001 年 1 月至 2016 年 12 月期间接受 PA 治疗的儿科患者（<16 岁）进行了回顾性病历分析。检索了人口统计学、临床和结局数据，并生成了描述性数据。

结果

在研究期间，80 例患者经微生物学证实患有 PA，其中 38 例（48%）在治疗过程中进行了手术干预。手术组中，有 19 名男性和 19 名女性，平均年龄为 9.4 岁（0.5-16 岁）。35 例（92%）患者处于免疫功能低下状态（其中 10 例曾接受过骨髓移植），2 例患者患有囊性肺部疾病，1 例患者患有硬皮病。所有患者在就诊时均有发热和呼吸道症状，并接受了全身抗真菌药物治疗。所有患者均行计算机断层扫描（CT）检查，显示出与疾病相关的特征。手术包括肺活检 13 例（34%）、节段切除术 12 例（32%）、肺叶切除术 8 例（21%）、清创术/空洞切除术 3 例（8%）和 2 例患者行肺切除术（5%）。组织病理学检查显示 20 例（53%）患者存在侵袭性真菌感染，18 例（47%）患者存在曲菌球。11 例（29%）患者因真菌感染和基础疾病死亡。另有 3 例患者（未纳入手术系列）在等待手术时因严重肺出血而死亡。所有患者 CT 扫描显示肺门附近有空腔。