Karas A, Hankins J R, Attar S, Miller J E, McLaughlin J S
Ann Thorac Surg. 1976 Jul;22(1):1-7. doi: 10.1016/s0003-4975(10)63943-4.
During the period 1969 to 1974, 41 patients having cultures positive for aspergillus were seen on the thoracic surgical services of the University of Maryland and Mt. Wilson State Hospitals. Intracavitary mycetoma was present in 36 patients. In 32 the underlying disease was chronic cavitary tuberculosis, 5 had decreased immunity due to other diseases, and in 3 no underlying disease was noted. One final patient developed a mycetoma following repair of tetralogy of Fallot. Hemoptysis, the predominant symptom, occurred in 23 patients, all of whom were from the group with intracavitary mycetoma. Hemoptysis was life-threatening in 8 patients, severe but not life-threatening in 12, and minimal in 3. Fifteen patients underwent pulmonary resection with 2 deaths. Both patients who died had undergone emergency resection for life-threatening hemoptysis; the fungus ball had developed following a previous resection for tuberculosis, and both had poor pulmonary reserve. Of 10 patients with hemoptysis who were not treated surgically, chiefly because they were poor operative risks, 4 died. This study suggests that pulmonary aspergillosis, particularly of the intracavitary type, is a potentially life-threatening disease. Because of the suddenness with which massive hemoptysis may occur, pulmonary resection is recommended for all patients with intracavitary mycetoma who do not constitute prohibitive operative risks.
在1969年至1974年期间，马里兰大学和威尔逊山州立医院的胸外科共收治了41例曲霉菌培养呈阳性的患者。36例患者存在腔内真菌瘤。其中32例的基础疾病为慢性空洞型肺结核，5例因其他疾病导致免疫力下降，3例未发现基础疾病。最后1例患者在法洛四联症修复术后发生真菌瘤。咯血是主要症状，23例患者出现咯血，均来自有腔内真菌瘤的患者组。8例患者咯血危及生命，12例严重但未危及生命，3例轻微。15例患者接受了肺切除术，2例死亡。死亡的2例患者均因危及生命的咯血接受了急诊手术；真菌球是在先前因肺结核进行切除术后形成的，且二者肺储备功能均较差。10例未接受手术治疗的咯血患者主要是因为手术风险高，其中4例死亡。本研究表明，肺曲霉菌病，尤其是腔内型，是一种潜在的危及生命的疾病。由于可能突然发生大量咯血，建议对所有不构成高手术风险的腔内真菌瘤患者进行肺切除术。
