心脏移植术后肺部真菌球2例

目的 总结心脏移植术后肺部真菌球的诊断及处理方法。方法 30例同种异体原位心脏移植患者中,2例术后早期并发肺部严重真菌感染(毛霉菌和曲霉菌)伴真菌球形成,主要依靠胸片、痰培养或组织培养确诊,均给予行手术切除病灶及二性霉素B治疗。结果 2例真菌感染得到控制,但均存在肝功能损害。1例长期存活,1例于移植后第17周因药物性肝损害并发暴发性肝炎致肝功能衰竭而死亡。结论 心脏移植后肺部真菌球较少见,死亡率高,外科切除病灶及二性霉素B联合处理效果较佳,应重在预防。

Diagnosis and treatment of pulmonary fungus balls in cardiac transplantation recipients:A report of 2 cases

Objective To review the diagnosis and treatment of pulmonary fungus balls in cardiac transplantation recipients. Methods From Aug 1995 to Aug 2001,30 patients with end-stage dilated cardiomyopathy underwent orthotopic cardiac transplantation. Two recipients suffered from severe invasive pulmonary fungal infection( mucoraceae and aspergillus)with fungus balls at early stage.Early diagnosis was mainly made by chest radiographs,sputum samples culture or tissue culture. Both received segmental resectional surgery of the pulmonary lobe along with removal of fungus balls under the coverage of modified dose of amphotericin B intravenous. Results Two recipients recovered from fungal infections, but both suffered from hepatic insufficiency. One recipient got prolonged survival with good quality of life.The other survived for 17 weeks and died as a result of the drug-induced hepatitis and fulminant viral hepatitis. Conclusion Pulmonary fungus balls in cardiac transplantation recipients are relatively rare, although their mortality rate is still very high. Successful treatment mainly depended on surgical procedure combined with amphotericin B intravenous ,and the prevention should be emphasized.