Bernard A, Loire J, Caillot D, Casasnovas O, Couailler J F, Guy H, Favre J P
Clinique Chirurgicale Universitaire, CHU, Hôpital du Bocage, Dijon.
Ann Chir. 1995;49(9):849-53.
Mortality due to Invasive Pulmonary Aspergillosis (IPA) remains high in neutropenic patients due to pulmonary haemorrhage. The aim of this study was to evaluate the emergency surgical management of IPA. Seven neutropenic patients, with a mean age of 47 years (range: 30-64) (4 women and 3 men) were treated for (6 cases) acute leukaemia one Myeloma (1 case). Presumptive diagnosis of IPA was based on: Halo sign (n = 6) or air-crescent sign (n = 1) on CT scan, positive serology (n = 4), positive antigenemia (n = 3) and positive broncho-alveolar lavage (n = 1). In 2 cases, IPA diagnosis was only based on CT scan. In all cases, aspergillosis lesions were located near the left (n = 5) or right (n = 2) pulmonary artery. The type of pulmonary resection was: left superior lobectomy in 3 cases, left superior lobectomy and Fowler's segmentectomy in 1 case, Left inferior lobectomy in 1 case, right superior lobectomy in 1 case and middle lobectomy and paracardiac segmentectomy. Sleeve resection of the pulmonary artery was performed in two patients. There were no deaths or major postoperative complications. Mean hospital stay after surgery was 12 days (rang: 8-19). Histological examination confirmed the diagnosis of IPA. CT is essential to determine the optimal timing for surgery.
由于肺出血，侵袭性肺曲霉病（IPA）导致的中性粒细胞减少患者死亡率仍然很高。本研究的目的是评估IPA的急诊手术治疗。7例中性粒细胞减少患者，平均年龄47岁（范围：30 - 64岁）（4名女性和3名男性），其中6例因急性白血病、1例因骨髓瘤接受治疗。IPA的初步诊断基于：CT扫描上的晕征（n = 6）或空气新月征（n = 1）、血清学阳性（n = 4）、抗原血症阳性（n = 3）和支气管肺泡灌洗阳性（n = 1）。2例中，IPA诊断仅基于CT扫描。所有病例中，曲霉病病变均位于左肺动脉（n = 5）或右肺动脉（n = 2）附近。肺切除类型为：3例行左上叶切除术，1例行左上叶切除术加福勒段切除术，1例行左下叶切除术，1例行右上叶切除术，1例行中叶切除术加心旁段切除术。2例患者进行了肺动脉袖状切除术。无死亡病例或重大术后并发症。术后平均住院时间为12天（范围：8 - 19天）。组织学检查确诊为IPA。CT对于确定手术的最佳时机至关重要。
