肺实质血吸虫病（裂体吸虫病）的手术治疗：20 年单中心经验。

Surgery for Pulmonary Parenchymatous Schistosomiasis (Bilharziomas): A 20-Year Single-Centre Experience.

机构信息

Department of Cardiovascular and Thoracic Surgery, Ain Shams University, Cairo, Egypt.

出版信息

Heart Lung Circ. 2020 Jul;29(7):1093-1100. doi: 10.1016/j.hlc.2019.07.015. Epub 2019 Aug 23.

DOI:10.1016/j.hlc.2019.07.015

PMID:31522932

Abstract

BACKGROUND

Pulmonary schistosomiasis may complicate urinary or intestinal infestations. Pulmonary pathology is either in the acute or chronic form. The chronic form of the disease may result in granuloma formation. This study presents 20 years of experience in surgical management of pulmonary bilharziomas.

METHODS

A retrospective review was undertaken of 17 consecutive patients who had surgery for lung bilharziomas from 1996-2016. Demographics, clinical presentation, underlying lung disease, investigations performed, operative procedure, and outcome were retrieved and reviewed.

RESULTS

All patients were males, with ages ranging from 22-52 years (median 33 years). Haemoptysis was the main presentation (53%). Coexisting lung tuberculosis was present in five (29.4%) patients. Indications for surgery were solitary shadows in 12 (70.6%) patients and persistent tuberculous cavities in five (29.4%) patients. Segmentectomy was performed in one (5.9%) patient, lingulectomy in one (5.9%) patient, lobectomy in 14 (82.3%) patients, and bi-lobectomy in one (5.9%) patient. The histologic nature of the infestation was: bilharzial ova with extensive granulomatous reaction and suppuration in eight cases (47%); both tuberculosis and bilharzial ova within a granulomatous tissue reaction in five cases (29.4%); and bilharzial ova within malignant tissue in four cases (23.6%). There was no operative mortality. One (1) patient (5.9%) developed postoperative bronchopleural fistula after left upper lobectomy; surgical repair of the fistula and omental flap buttress was needed after failure of conservative management.

CONCLUSION

Pulmonary schistosomiasis is not an uncommon infestation and occurs more frequently in patients with underlying tuberculosis. It may predispose to granulomatous parenchymatous lung masses or even malignancy, which necessitate surgical intervention with a good outcome. However, predisposition of pulmonary schistosomiasis for the development of bronchogenic carcinoma warrants further studies.

摘要

背景

肺血吸虫病可能并发尿路或肠道感染。肺病理学表现为急性或慢性形式。该疾病的慢性形式可能导致肉芽肿形成。本研究介绍了 20 年来手术治疗肺血吸虫病的经验。

方法

对 1996 年至 2016 年期间因肺血吸虫病接受手术治疗的 17 例连续患者进行回顾性分析。检索并回顾了患者的人口统计学资料、临床表现、基础肺部疾病、检查、手术程序和结果。

结果

所有患者均为男性，年龄 22-52 岁（中位数 33 岁）。咯血是主要表现（53%）。5 例（29.4%）患者同时患有肺结核。手术指征为 12 例（70.6%）患者的孤立性阴影和 5 例（29.4%）患者的持续性结核性空洞。1 例（5.9%）患者行节段切除术，1 例（5.9%）患者行舌切除术，14 例（82.3%）患者行肺叶切除术，1 例（5.9%）患者行双肺叶切除术。感染的组织学性质为：8 例（47%）为血吸虫卵伴广泛肉芽肿性反应和化脓；5 例（29.4%）为结核和血吸虫卵均在肉芽肿组织反应中；4 例（23.6%）为恶性组织内的血吸虫卵。无手术死亡。左肺上叶切除术后 1 例（5.9%）患者发生术后支气管胸膜瘘；经保守治疗失败后，需要手术修复瘘管和网膜瓣支撑。