He Binchan, Wan Choihong, Zhou Wei, Rui Yuwen, Shi Yi, Su Xin
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University Nanjing 210002, China.
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University Guangzhou, China.
Am J Transl Res. 2019 Jun 15;11(6):3671-3679. eCollection 2019.
Chronic pulmonary aspergillosis (CPA) has been reclassified as several different subtypes, and the clinical features of the different types should be further investigated. Surgery is a remedial option for patients who experience pharmacological treatment failure, though more information about the effectiveness and prognosis of surgical treatment and perioperative medication for different types of CPA is needed.
This was a retrospective study of patients with proven CPA who underwent surgery between January 2001 and June 2018 at Nanjing Jinling Hospital.
Sixty patients underwent surgery. The median age was 52.5 years (22-80), and chronic cavitary pulmonary aspergillosis (CCPA) accounted for the largest proportion of cases (46.7%). The most common presenting symptom was hemoptysis (70%). Many patients had underlying lung disease, including bronchiectasis (30%) and obsolete tuberculosis (TB) (21.7%). The surgical procedures included lobectomy (76.7%), wedge resection (16.7%), segmentectomy (5%) and pneumonectomy (1.7%). In total, 33 patients (62.3%) received perioperative antifungal treatment, all of whom improved or were cured. Conversely, 22 patients did not receive perioperative anti- treatment; among them, 3 patients with subacute invasive aspergillosis (SAIA) and 1 with CCPA experienced disease progression or died.
Surgery is needed in some patients with refractory CPA. We consider that SAIA and CCPA patients may benefit from perioperative antifungal therapy. However, due to the limited number of patients in this study, more evidence is needed to draw a conclusion about this issue.
慢性肺曲霉病（CPA）已被重新分类为几种不同的亚型，不同类型的临床特征有待进一步研究。手术是药物治疗失败患者的补救选择，不过对于不同类型CPA的手术治疗效果、预后及围手术期用药，仍需要更多信息。
这是一项对2001年1月至2018年6月在南京金陵医院接受手术的确诊CPA患者的回顾性研究。
60例患者接受了手术。中位年龄为52.5岁（22 - 80岁），慢性空洞型肺曲霉病（CCPA）占病例的最大比例（46.7%）。最常见的症状是咯血（70%）。许多患者有基础肺部疾病，包括支气管扩张（30%）和陈旧性肺结核（TB）（21.7%）。手术方式包括肺叶切除术（76.7%）、楔形切除术（16.7%）、肺段切除术（5%）和全肺切除术（1.7%）。共有33例患者（62.3%）接受了围手术期抗真菌治疗，所有患者均好转或治愈。相反，22例患者未接受围手术期抗真菌治疗；其中，3例亚急性侵袭性曲霉病（SAIA）患者和1例CCPA患者病情进展或死亡。
一些难治性CPA患者需要手术治疗。我们认为SAIA和CCPA患者可能从围手术期抗真菌治疗中获益。然而，由于本研究中的患者数量有限，需要更多证据才能就此问题得出结论。
