Csekeo A, Agócs L, Egerváry M, Heiler Z
Koranyi National Institute, Thoracic Surgery Clinic and Pathology Department, Budapest, Hungary.
Eur J Cardiothorac Surg. 1997 Dec;12(6):876-9. doi: 10.1016/s1010-7940(97)00272-8.
Surgery of pulmonary aspergillosis followed by higher incidence of post-operative complications. This was the purpose to evaluate our material.
Between January 1983 and December 1995, the operation was carried out on a total of 84 patients for pulmonary aspergillosis. The patients were comprised of 71 males and 13 females, with a mean age of 49 years (range, 24-71). Previous lung disorders were observed in about half of the cases (most frequently tuberculosis), while in the other half aspergillosis was developed on the basis of (sub)-acute infections. Haemoptysis was present in 48% of patients. The diagnosis was suspected in 47 cases by chest X-ray. Aspergilloma was diagnosed in 50 patients pre-operatively (excluding 12 typical aspergillomas for cavernostomies), with the other pre-operative diagnoses being tuberculosis, lung cancer, pyoscelrosis, etc.
In 71 cases pulmonary resection was carried out (52 lobectomies, 13 wedge resections and six pulmonectomies). A total of 12 cavities were opened by cavernostomy and one lung biopsy was performed for disseminated lung disease. The post-operative mortality rate was 9.5%. The most common complications were bleeding, empyema, bronchial fistula and wound infection. In 23 patients with developed prolonged air leak and/or residual air space, complications were observed more frequently in patients with greater cavitation near the chest wall.
In most cases of pulmonary aspergilloma surgical intervention remains the only effective therapy. The operation has a lower risk factor in asymptomatic patients and in patients without pleural or chest wall involvement. In some cases, cavernostomy may be the only remaining surgical choice.
肺曲霉病手术后并发症发生率较高。本研究旨在评估我们的病例资料。
1983年1月至1995年12月，共对84例肺曲霉病患者实施了手术。患者包括71例男性和13例女性，平均年龄49岁（范围24 - 71岁）。约一半病例既往有肺部疾病（最常见的是肺结核），另一半病例曲霉病是在（亚）急性感染基础上发生的。48%的患者有咯血症状。47例患者通过胸部X线检查怀疑诊断。术前50例患者诊断为曲菌球（不包括12例用于空洞造口术的典型曲菌球），其他术前诊断为肺结核、肺癌、脓胸等。
71例患者实施了肺切除术（52例肺叶切除术、13例楔形切除术和6例全肺切除术）。通过空洞造口术共打开12个空洞，对1例播散性肺部疾病患者进行了肺活检。术后死亡率为9.5%。最常见的并发症是出血、脓胸、支气管瘘和伤口感染。23例出现持续性漏气和/或残留气腔的患者中，胸壁附近空洞较大的患者并发症更常见。
在大多数肺曲菌球病例中，手术干预仍然是唯一有效的治疗方法。对于无症状患者以及无胸膜或胸壁受累的患者，手术风险较低。在某些情况下，空洞造口术可能是唯一剩下的手术选择。
