中性粒细胞减少患者的局限性侵袭性肺曲霉病。手术切除的有效性。
Localized invasive pulmonary aspergillosis in patients with neutropenia. Effectiveness of surgical resection.
作者信息
Moreau P, Zahar J R, Milpied N, Baron O, Mahé B, Wu D, Germaud P, Despins P, Delajartre A Y, Harousseau J L
机构信息
Department of Hematology, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France.
出版信息
Cancer. 1993 Dec 1;72(11):3223-6. doi: 10.1002/1097-0142(19931201)72:11<3223::aid-cncr2820721115>3.0.co;2-r.
BACKGROUND
Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with neutropenia. Two severe complications with poor outcome can be observed after apparently successful IPA medical treatment: severe hemoptysis and IPA relapse during subsequent cytotoxic treatments. Early surgical therapy has not been considered routinely in the management of localized IPA.
METHODS
Six consecutive patients (four women, two men; median age, 52 years) with localized cavitating IPA diagnosed during chemotherapy-induced aplasia were treated with early surgical resection after hematologic recovery.
RESULTS
All patients received a lobectomy. Surgery was uneventful. This procedures allows patients to proceed with further intensive chemotherapy and/or bone marrow transplantation without IPA reactivation.
CONCLUSIONS
For selected patients, surgical resection of localized IPA with unique cavitating lesion, which prevents hemoptysis and IPA recurrence and allows for subsequent cytotoxic treatment, may be recommended.
背景
侵袭性肺曲霉病（IPA）是中性粒细胞减少患者发病和死亡的主要原因。在IPA药物治疗明显成功后，可观察到两种预后不良的严重并发症：严重咯血和后续细胞毒性治疗期间的IPA复发。在局限性IPA的管理中，早期手术治疗尚未被常规考虑。
方法
连续6例（4例女性，2例男性；中位年龄52岁）在化疗诱导的再生障碍性贫血期间诊断为局限性空洞性IPA的患者，在血液学恢复后接受了早期手术切除。
结果
所有患者均接受了肺叶切除术。手术过程顺利。该手术使患者能够继续进行进一步的强化化疗和/或骨髓移植，而不会出现IPA再激活。
结论
对于选定的患者，推荐对具有独特空洞性病变的局限性IPA进行手术切除，这可预防咯血和IPA复发，并允许进行后续的细胞毒性治疗。
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