Jung J Y, Almond C H, Campbell D C, Elkadi A, Tenorio A
J Thorac Cardiovasc Surg. 1979 Feb;77(2):234-9.
Management of four patients with sporotrichosis is summarized; one was treated medically and three were treated surgically. Thirty-seven cases from the literature are reviewed. The role of surgery in the management of pulmonary sporotrichosis is outlined as follows: (1) diagnosis of pulmonary infiltrates and/or pulmonary cavities of undetermined origin, (2) surgical intervention in patients with persistent infiltrates with cavitary lesions resulting from sporotrichosis, following failed medical treatment, and (3) resection of associated pulmonary cavitary lesions in patients in spite of adequte medical control of sporotrichosis. Surgical principles that must be observed in the management of pulmonary sporotrichosis follows:(1) Resection is the procedure of choice. The magnitude ranges from segmental resection to pneumonectomy. Clean resection is necessary. (2) Antifungal drug therapy--preferably with amphotericin B--is advisable preoperatively and postoperatively, since the major cause of late death is progression of the disease when clean resection has not been feasible. (3) Resection combined with drug therapy can be curative without increased risk in physiologically operable and anatomically resectable disease. (4) Thoracoplasty can be a lifesaving procedure for bilateral cavitary lesions with severe hemoptysis in patients with impaired pulmonary functions.
总结了4例孢子丝菌病患者的治疗情况；1例接受药物治疗，3例接受手术治疗。回顾了文献中的37例病例。手术在肺孢子丝菌病治疗中的作用概述如下：（1）诊断不明原因的肺部浸润和/或肺空洞；（2）药物治疗失败后，对患有孢子丝菌病导致的持续性浸润伴空洞性病变的患者进行手术干预；（3）尽管孢子丝菌病已得到充分的药物控制，但仍对相关肺空洞性病变患者进行切除。肺孢子丝菌病治疗中必须遵循的手术原则如下：（1）切除是首选方法。切除范围从肺段切除到全肺切除。必须进行彻底切除。（2）术前和术后建议使用抗真菌药物治疗——最好使用两性霉素B——因为在无法进行彻底切除时，晚期死亡的主要原因是疾病进展。（3）对于生理上可手术且解剖上可切除的疾病，手术切除联合药物治疗可治愈且不会增加风险。（4）胸廓成形术对于肺功能受损、双侧空洞性病变伴严重咯血的患者可能是一种挽救生命的手术。
