Lee K S, Kim H T, Kim Y H, Choe K O
Department of Radiology, College of Medicine, Soonchunhyang University, Bongmyung-Dong, Chunan, Korea.
AJR Am J Roentgenol. 1993 Oct;161(4):727-31. doi: 10.2214/ajr.161.4.8372746.
Surgery has been the primary choice of treatment for cavitary aspergillomas of the lung, but it is associated with relatively high morbidity and mortality. The effectiveness of percutaneous intracavitary instillation of an antifungal agent in seven patients with hemoptysis caused by cavitary aspergilloma was evaluated.
All patients had hemoptysis associated with a cavitary pulmonary aspergilloma. In four patients who had aspergillomas without lung interposed between the cavity and the chest wall, 50 mg of amphotericin B in 10 ml of 5% dextrose in water and then 8 mg of bromhexine (a mucolytic agent) mixed with 10 ml of normal saline were instilled into the cavity through an 8-French catheter daily for 15 days. In three patients who had lung interposed between the cavity and the chest wall, the treatment was administered twice at 3-day intervals through a 20-gauge needle. The presence or absence of hemoptysis was recorded after each instillation of amphotericin B, and the size of aspergilloma was assessed with follow-up radiographs.
Hemoptysis ceased within 5 days after instillation of amphotericin B in all patients. In the four patients treated through a catheter, the aspergillomas resolved completely in three patients and resolved partially in one. In the three patients treated through a fine needle, the aspergillomas resolved partially. Mild hemoptysis during the procedure, a small pneumothorax, and subcutaneous emphysema occurred in one patient each.
Our results suggest that percutaneous intracavitary instillation of amphotericin B is a safe and effective method of treating hemoptysis caused by aspergillomas.
手术一直是肺空洞型曲菌球的主要治疗选择，但它伴随着相对较高的发病率和死亡率。评估了经皮腔内注入抗真菌药物对7例由空洞型曲菌球引起咯血患者的疗效。
所有患者均有与空洞型肺曲菌球相关的咯血。4例空洞与胸壁之间无肺组织间隔的曲菌球患者，通过8F导管每日向空洞内注入10ml 5%葡萄糖溶液溶解的50mg两性霉素B，然后再注入与10ml生理盐水混合的8mg溴己新（一种黏液溶解剂），持续15天。3例空洞与胸壁之间有肺组织间隔的患者，通过20G针头每3天给药1次。每次注入两性霉素B后记录有无咯血情况，并通过随访X线片评估曲菌球大小。
所有患者在注入两性霉素B后5天内咯血停止。在4例通过导管治疗的患者中，3例曲菌球完全消退，1例部分消退。在3例通过细针治疗的患者中，曲菌球部分消退。1例患者在治疗过程中出现轻度咯血、1例出现小气胸、1例出现皮下气肿。
我们的结果表明，经皮腔内注入两性霉素B是治疗曲菌球引起咯血的一种安全有效的方法。
