Results of surgical treatment for pulmonary aspergilloma with 26 cases in six years: a single center experience

Surgery for pulmonary aspergilloma is reputed to be risky. We analyzed our results of the surgical treatment for pulmonary aspergilloma. Between 2003 and 2009, 26 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our center. Results were evaluated retrospectively. There were 5 female and 21 male patients, with a mean age of 44 ± 11.6 years (28-70). The patients were divided into two groups, group A (simple aspergilloma; n= 8) and group B (complex aspergilloma; n= 18). Major underlying diseases were tuberculosis (61.5%). The most common indication for operation was hemoptysis (57.6%). Of our patients, 23% were complaining of massive hemoptysis or recurrent hemoptysis. Other patients were complaining of mild symptoms and some of them were totally asymptomatic. We performed 15 (57.6%) lobectomies (3 with associated segmentectomies), 8 (30.6%) segmentectomies/wedge resections, 2 (7.6%) pneumonectomies, and 1 (3.8%) cavernoplasty. Postoperative complications occurred in 15 (57.6%) patients. Complications occurred in 72.2% patients of complex aspergilloma, whereas 25% occurred in simple aspergilloma (p= 0.03). Major complications included prolonged air leak, empyema, air space. One patient who underwent lobectomies for complex aspergilloma developed bronchopleural fistula and died of respiratory failure on the 20th postoperative day. Operative mortality was 3.8%. The average postoperative hospital stay was 12.9 days. The mean follow-up period was average 44 months. The actuarial survival at 3 years was 90% and 100% for complex aspergilloma and simple aspergilloma, respectively (p> 0.05). There was two recurrence of disease (8%). But no recurrence of hemoptysis. Low morbidity rate may have been due to the selection of patients with localized pulmonary disease in this study. Surgical resection of asymptomatic or symptomatic pulmonary aspergilloma is effective in preventing recurrence or massive hemoptysis for patients whose condition is fit for pulmonary resection with reasonable mortality, morbidity and survival rates.     

Role and outcome of surgery for pulmonary tuberculosis

The need and outcome of surgical intervention in patients with pulmonary tuberculosis were assessed retrospectively. Between 1993 and 2003, 72 major surgical procedures were performed in 57 patients with pulmonary tuberculosis. There were 44 males and 13 females with a mean age of 34 years. Indications for surgery were: trapped lung in 18 (31.6%), multidrug-resistant tuberculosis in 10 (17.5%), aspergilloma in 10 (17.5%), destroyed lung in 5 (8.8%), massive hemoptysis in 4 (7%), bronchopleural fistula in 3 (5.3%), persistent cavity in 2 (3.5%), and undiagnosed nodule in 5 (8.8%) patients. The most common procedure was lobectomy (31.9%). Other procedures included decortication, wedge resection, pneumonectomy, segmentectomy, and myoplasty. There were 28 complications in 18 patients, including prolonged air leak in 12 (21.1%), residual space in 7 (12.3%), empyema in 5 (8.8%), hematoma in 2 (3.5%), chylothorax and bronchopleural fistula in 1 (1.8%) each. There was no operative death, but one patient died from sepsis late in the follow-up period (mortality, 1.8%). As morbidity and mortality rates are acceptable, surgical intervention can be considered safe and effective in patients with pulmonary tuberculosis.     

肺结核合并肺曲菌球病的外科治疗

目的总结肺结核合并肺曲菌球病的诊断和外科治疗经验。方法对经手术治疗的24例肺结核合并肺曲菌球病患者的临床资料进行分析。结果 24例患者术前确诊率为37.5%(9/24)。行肺叶切除术20例,全肺切除术4例,19例同时行肥厚胸膜切除术。全组无手术死亡。术后并发症8例(33.3%),分别为胸腔出血1例,支气管胸膜瘘3例,包裹性液气胸2例,肺不张2例。术后随访22例,患者无肺曲菌球病复发。结论肺结核合并肺曲菌球病术前确诊率低;手术切除病变肺叶及肥厚胸膜是治疗肺结核合并肺曲菌球病的有效方法。     

Place of surgery in pulmonary aspergillosis and other pulmonary mycotic infections

Surgery is part of the therapeutic strategy of aspergillosis and mucormycosis. The aspergilloma is defined as a rounded mass, developing in a cavity by the proliferation of spores of Aspergillus. The most common complication was haemoptysis reported in 50-95% of cases. The pleuropulmonary lesions predisposing are: tuberculosis, residual pleural space, emphysema and lung destroyed by fibrosis or radiotherapy or bronchiectasis. The indications for surgery depend on symptoms, respiratory function, the parenchyma and the type of aspergilloma (simple or complex). In a patient with an intrapulmonary aspergilloma, lung resection preceded by embolization is recommended based on respiratory function. For intrapleural aspergilloma, thoracoplasty is recommended according to the patient's general condition. The invasive pulmonary aspergillosis (IPA) is characterized by an invasion of lung tissue and blood vessels by hyphae in immunocompromised patients. The death rate of patients who have an API after treatment for leukemia or lymphoma was 30 to 40%, after bone marrow transplantation 60%, after solid organ transplantation from 50 to 60% and after any other cause of immunocompromising from 70 to 85%. The main cause of these deaths is massive hemoptysis. Surgery (lobectomy) is indicated for the prevention of hemoptysis when the mass is in contact with the pulmonary artery or one of its branches, and if it increases in size with the disappearance of border security between the mass and the vessel wall. The patient will be operated in an emergency before the white blood cells do not exceed the threshold of 1000 cells/μl. A persistent residual mass after antifungal treatment may justify a lung resection (lobectomy or wedge) before a new aggressive therapy. Mucormycosis affects patients following immunocompromising states--haematologic malignancy, diabetes mellitus, transplantation, burns and malnutrition. The treatment of pulmonary mucormycosis combines surgical and medical approach.     

Cavernostomy and simultaneous removal of fungus ball of pulmonary aspergilloma]

Between 1991 and 2000, 21 patients (16 male and 5 female) underwent 28 cavernostomies for the treatment of pulmonary aspergilloma. The median age was 59.4 years (range 37-85 years). The mean %VC was 59.6 (range 30.4-91.2), and the mean FEV 1.0 was 1.51 ml (range 0.64-2.67 ml). The mean body mass index was 17.6 (range 12.7-23.2). The most common complaint was hemoptysis. The underlying lung disease was tuberculosis in 17 cases, atypical mycobacteriosis in 2, and unclassified in 2. All cases had been diagnosed as complex aspergilloma. The mean surgical duration was 136 minutes (range 85-203 min.) and the mean blood loss during surgery was 242 ml(range 5-810 ml). No death or major complications occurred in the postoperative course. During follow-up, 4 patients died of massive hemoptysis, cancer, respiratory failure or an unknown cause. Relapses of aspergilloma occurred in 9 patients (42.9%). Recavernostomy was performed safely on 5 patients. In conclusion, although the relapse rate of aspergilloma was high after cavernostomy, safe reoperations were performed. Cavernostomy is thus an effective treatment in high-risk patients.     

Favorable acute and long-term outcomes after the resection of pulmonary aspergillomas

OBJECTIVE: This retrospective study was designed to examine the acute and long-term outcomes after surgical treatment of patients with pulmonary aspergillomas. PATIENTS AND METHODS: From 1992 to 2006, 24 patients (21 men, mean age 58.4 years) with pulmonary aspergillomas underwent pulmonary resection. Operative indications were massive or repetitive hemoptysis in 6 patients, medically unmanageable localized infection in 14 patients, and undetermined mass in 4 patients. Eighteen patients (75.0 %) had background pulmonary diseases and four patients (16.7 %) were mildly immunocompromised. Eight patients had simple aspergillomas, while sixteen patients had complex aspergillomas. Two patients with pleural empyema had their pleural spaces sterilized before pulmonary resections. Fungus balls and pulmonary cavities along with the surrounding lung were removed in all patients. RESULTS: Surgical procedures consisted of 13 lobectomies, 5 pneumonectomies including one completion pneumonectomy, 2 segmentectomies and 4 wedge resections. Postoperative complication occurred in 10 patients (41.6 %) and one patient died from aortic bleeding due to postoperative empyema. Other major complications were prolonged air leaks, bleeding, and chylothorax. In the follow-up period, all but one patient were free from aspergillosis. Hemoptysis was not seen in any patient. Overall survival rates at 2, 5, and 10 years were 86.6 %, 79.4 % and 79.4 %, respectively. Disease-free survival rates from aspergillosis were 86.6 %, 72.6 % and 72.6 % at 2, 5, and 10 years, respectively. CONCLUSION: Pulmonary resection for aspergilloma showed favorable acute and long-term outcomes when surgical treatment was applied in selected patients.     

Surgical results in bronchiectasis: analysis of 149 patients

Bronchiectasis remains a serious problem in developing countries. We reviewed the morbidity, mortality, and functional outcome of surgical treatment for bronchiectasis in our institution. Between 1992 and 2003, 149 patients (105 males, 44 females) underwent pulmonary resection for bronchiectasis. Their mean age was 33.7 years (range, 5-66 years). The indications for surgery were failure of conservative treatment in 59 (40%) patients, recurrent hemoptysis in 53 (36%), bronchial obstruction by a tumor in 9 (6%), and destroyed lung in 28 (19%). Bilateral disease was seen in 24 (16%) patients. Surgical treatment included pneumonectomy in 55 (37%) patients, lobectomy in 55 (37%), bilobectomy in 37 (25%), and lobectomy and/or segmentectomy in 2 (1%). There was one operative death (mortality, 0.67%) and morbidity occurred in 22 (14.8%) patients. Follow-up was complete in 94 patients, for a mean of 4.8 years (range, 3 months to 12 years). After surgery, 51 (34%) patients were asymptomatic. Surgical treatment for bronchiectasis can achieve good results with acceptable morbidity and mortality, not only in localized disease but also in extensive disease, if complete resection can be achieved.     

Severe hemoptysis associated with pulmonary aspergilloma. Percutaneous intracavitary treatment

Surgical therapy for massive hemoptysis associated with pulmonary aspergilloma carries a high morbidity and mortality in patients with limited pulmonary reserve. Bronchial artery embolization has proven ineffective in treating and in preventing recurrent episodes of hemoptysis in this group of patients. Over a four-and-one-half year period, we have successfully treated six episodes of acute hemoptysis in four patients using a percutaneously placed catheter and intracavitary instillation of amphotericin B, N-acetylcysteine, and aminocaproic acid. Advantages of this method of treatment for patients with severely compromised pulmonary reserve include: (1) no further loss of lung function; (2) ease and rapidity of catheter insertion; (3) prompt response to treatment; (4) relatively short hospitalization; and (5) ability to repeat the procedure in the same or another cavity if necessary.     

肺曲菌球病63例临床分析

目的探讨肺曲菌球病的临床特征和治疗方案。方法回顾性分析2008.1~2014.10年收治63例病理确诊肺曲菌球病患者的临床诊治情况。结果 HCT37%24例,血清前白蛋白(PA)200 mg/L20例,LY1.5×10~9/L 19例;肺结核空洞22例,支气管扩张症19例,6例无明确基础疾病;咳嗽46例,咯血59例,大咯血29例。典型影像学表现48例,误诊4例,漏诊11例;可见纵隔淋巴结23例,短径小于1 cm,淋巴结活检提示反应性增生。病灶位于左肺上叶17例,右肺上叶29例。肺功能检查:总弥散量低于比弥散量(t=-9.422,P0.001);均行外科手术治疗;58例随访影像学未见复发;大咯血与相关危险因素的Logistic分析,肺结核空洞OR=6.113,P=0.008,空洞或空腔内长径OR=2.410,P=0.004。结论肺曲菌球病咯血和咳嗽为主要症状;病灶多位于双肺上叶,影像学特征典型,大咯血患者的曲菌球长径、空洞或空腔长内径长于非大咯血患者;弥散功能有一定特征性;首选手术治疗;肺结核空洞和空洞或空腔内长径是大咯血的危险因素。     

The surgical emergent therapy for massive hemoptysis in 52 cases]

The result of surgical emergent operation in 52 cases with massive hemoptysis failed by medical therapy was reported. Hemoptysis ceased in 51 of the 52 cases. One patient died after operation, giving a mortality rate of 1.9%. Other complications were occurred in two patients, but none was bronchial fistula. The complication rate was 3.8%. The surgical indication of this series would include: (1) The amount of hemoptysis more than 600 ml per 24 h, failed by medical treatment. (2) Massive hemoptysis repeated or a history of suffocation. (3) Irreversible lesion in the lung with the bleeding site identified accurately. (4) The general condition and vital organs of the patient would permit surgical therapy. Various types of pulmonary resection with successful results should be selected.     

肺曲菌球手术治疗(附10例报告)

本文报告10例肺曲菌球外科手术治疗的经验。由于抗菌素，激素和免疫抑制剂的广泛应用，肺曲菌球的发病率有逐渐增加的趋势。本组病例的主要临床症状是咳血，有典型的肺曲菌球X线表现者4例，其余6例均被误诊并行抗结核治疗数年。内科治疗对肺曲菌球无明显疗效。当频繁大量咳血，不能除外恶性或手术有助于原有基础病变的治疗，则应行外科处理。一般多行肺叶切除，偶而局部肺切除或病灶摘除也可获满意疗效。     

肺结核并发肺曲菌球47例外科治疗

目的　探讨肺曲菌球与肺结核的关系及其诊断和治疗;方法 对13年经外科手术治疗的47例肺结核合并曲菌球病人进行回顾性分析;结果 男性31例,占66.0%,病程>5年27例。咯血症状突出,41例,占87.2%。47例肺结核合并曲菌球中,术前明确诊断32例,占68.1%,漏误诊率31.8%。45例治愈,占95.7%,死亡2例,占4.2%。术后并发症10例,分别为胸腔感染、支气管胸膜瘘、肺炎、肺不张、支气管哮喘、呼吸衰竭和失血性休克。结论 肺曲菌球病见于肺结核空洞患者,在长期规律抗结核治疗后仍反复咯血,漏诊率较高,手术治疗为首选,效果较好。     

Endovascular management of a left subclavian artery lesion following thoracoplasty for bronchopleural fistula and empyema secondary to aspergillus fumigatus

Massive and/or recurrent hemoptysis is a clear indication for surgical treatment of pleuropulmonary aspergilloma, despite the incidence of postoperative morbidity and mortality. Thoracoplasty has been widely used for 20 years and is still indicated in these cases, following lobectomy, even though the procedure is not free of complications. We report the case of a patient who required thoracoplasty to treat a pleuropulmonary aspergilloma invading the chest wall. Subsequent placement of an aortic stent-graft was required due to tearing of the left subclavian artery.     

肺曲霉病外科治疗分析(附15例报告)

目的:探讨肺曲霉病的诊断、外科手术治疗原则、方法及效果。方法:回顾性分析我科2005年至2011年手术治疗的15例采用外科手术治疗的肺曲霉病患者的临床资料和随访结果。结果:15例患者术后证实均为曲霉病,术前诊断符合率为93.3%(14/15),影像学诊断符合率为73.3%(11/15),全组无手术死亡,随访4个月～6年无肺曲霉病复发和播散。结论:手术治疗肺曲霉病能消除症状,预防咯血复发,减少抗真菌药物对患者影响,可根治进而延长患者生命提高患者生活质量。因此,一旦确诊应积极手术治疗。     

Redefining the Risk of Surgery for Clinical Stage IIIA (N2) Non-Small Cell Lung Cancer: A Pooled Analysis of the STS GTSD and ESTS Registry

Background

Management of clinical stage IIIA-N2 (cIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. We evaluated treatment strategies and outcomes in cIIIA-N2 NSCLC patients who underwent pulmonary resection in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) and the European Society of Thoracic Surgeons (ESTS) Registry.

Methods

The STS GTSD and ESTS Registry were queried for patients who underwent pulmonary resection for cIIIA-N2 NSCLC between 2012 and 2016. Demographic variables, treatment strategies, and outcome measures were collected and analyzed. Significance of differences was determined using the χ² test for categorical variables and the Wilcoxon rank sum test for continuous variables.

Results

Pulmonary resection was performed in 4279 cIIIA-N2 NSCLC patients (2928 STS GTSD; 1351 ESTS). Induction therapy was administered to 49%. Lobectomy was performed in 67.1% and pneumonectomy in 13%. Lobectomy was associated with 19.2% major morbidity and 1.6% operative mortality, while pneumonectomy was associated with 34.1% and 5%, respectively. Induction therapy was associated with a higher rate of major morbidity or mortality than upfront surgery (23.2% vs 19.5%, p = 0.004), driven by pneumonectomy (40.7% vs 30.3%, p = 0.012) rather than lobectomy (20.3% vs 18.8%, p = 0.31).

Conclusions

Pulmonary resection for cIIIA-N2 NSCLC is associated with low rates of operative morbidity and mortality, with lobectomy having lower morbidity and mortality than pneumonectomy. Induction therapy, particularly chemoradiotherapy, is associated with a higher rate of composite morbidity or mortality than upfront surgery in pneumonectomy patients but not lobectomy patients.

     

Surgery for pulmonary aspergilloma and pleural aspergillosis

Pulmonary aspergilloma and pleural aspergillosis are a potentially lifethreatening disease resulting from the colonization of lung or pleural cavities by the ubiquitous fungus Aspergillus fumigatus. Twenty four patients with pulmonary aspergilloma and five with pleural aspergillosis underwent major thoracic procedures at our hospital between 1976 and 1986. Fourteen of the patients had haemoptysis, in 9 it was recurrent, and in 5 life-threatening. Tuberculosis, pneumonia, and sarcoidosis were the most common preexisting lung lesions. Surgical procedures included 7 pleuropneumonectomies, 18 lobectomies and 4 wedge resections. The postoperative mortality rate was approximately 7% (2 pat.). Based on the pathological examination 4 patients had unexpectedly a bronchial carcinoma in addition to the aspergilloma. Bronchopleural fistula with persistent air space was a serious complication only for patients after pleuropneumonectomy. 23 patients including those with complex aspergilloma and pleural infection had no postoperative complications; in none of the 27 operative survivors were there any recurrent symptoms over a follow-up between one and ten years. Good-risk patients with documented aspergilloma, even asymptomatic, should be resected, because of the danger of exsanginating haemorrhage. For patients with pleural aspergillosis only the aggressive resection can provide effective long term palliation.     

Pedicled Latissimus Dorsi Muscle Flap: Routine Use in High-Risk Thoracic Surgery

Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. Seven of the patients were chronically immunosuppressed, 5 were severely malnourished (median preoperative serum albumin level, 2.4 g/dL), and 5 had severe underlying obstructive pulmonary disease (median forced expiratory volume in 1 second, 44% of predicted level). Three upper lobectomies and 1 completion pneumonectomy were performed in order to treat massive hemoptysis that was secondary to complex aspergilloma. One patient underwent left pneumonectomy due to ruptured-cavitary primary lung lymphoma. One upper lobectomy was performed because of necrotizing, localized Mycobacterium avium-intracellulare infection. One patient underwent right upper lobectomy and main-stem bronchoplasty for carcinoma after chemoradiation therapy. In 3 patients, the pedicled latissimus dorsi muscle was used to obliterate chronic empyema cavities and to buttress the closure of underlying bronchopleural fistulas. No operative deaths or recurrent empyemas resulted. Two patients retained peri-flap air that required no surgical intervention.We conclude that the use of transposed pedicled latissimus dorsi muscle flap effectively and reliably prevents clinically overt bronchopleural fistula and recurrent empyema. We advocate its routine use in first-time and selected reoperative thoracotomies in patients who are undergoing high-risk lung resection or reparative procedures.Key words: Bronchial fistula/prevention & control/surgery, empyema, pleural/etiology/prevention & control/surgery, muscle, skeletal/surgery/transplantation, pleural diseases/prevention & control/surgery, pneumonectomy/adverse effects, postoperative complications, reconstructive surgical procedures, risk factors, surgical flaps/methods, thoracic surgical procedures/methods, treatment outcomeBronchopleural fistula (BPF) and empyema are rare but dangerous complications of pulmonary resections. The incidence of postoperative BPF, reported as 1.5% to 28%,^1–4 has been shown in general to relate to the condition''s cause and to the surgical technique and experience of the surgeons.^5–7 The incidence of empyema after pulmonary resections is between 2% and 16%.^8–10 Anatomic lung resections (for example, lobectomy and pneumonectomy) that are performed to treat inflammatory and infectious conditions particularly invite the development of these postoperative complications.Given the high morbidity and mortality rates of postoperative BPF and recurrent empyema, prevention is paramount. The use of transposed extrathoracic muscle flaps to cover bronchial stumps and to eliminate dead space is a well-established management technique.We have routinely used the pedicled latissimus dorsi (PLD) muscle flap as our preferred flap in high-risk thoracic surgery patients who have undergone lobectomy, pneumonectomy, or decortication procedures. Here, we review our experience with this technique in 10 patients, and the clinical outcomes thereof.     

Relationship of carbon monoxide pulmonary diffusing capacity to postoperative cardiopulmonary complications in patients undergoing pneumonectomy

This retrospective analytic study evaluated whether abnormal diffusing capacity for carbon monoxide (DLCO) is a predictor of postoperative morbidity and mortality in patients undergoing pneumonectomy for lung cancer. The medical records of patients undergoing pneumonectomy at Vancouver General Hospital between January 1992 and December 1997 were reviewed. Postoperative complications occurring within 30 days of resection were classified into mortality, and cardiovascular, pulmonary, and technical complications. A total of 151 pneumonectomy cases were reviewed. There were 100 men (66%) and 51 women (34%) with a mean age of 61 years. Complications occurred in 73 patients (48%), including mortality in eight (5%), cardiovascular morbidity in 50 (33%), pulmonary morbidity in 30 (20%), and technical morbidity in 22 (15%). Arrhythmia (21%) and pulmonary edema (13%) were the two major cardiovascular complications. Patients with complications had a greater smoking history, a longer hospital stay, a lower forced expiratory volume in 1 second (FEV1), a lower FEV1/forced vital capacity (FVC) ratio, a lower DLCO, and a lower DLCO/alveolar volume (VA) ratio than patients without complications. A DLCO of 70% predicted was the best functional predictor of postoperative complications, with a complication rate of 94% in patients with a DLCO of less than 70% predicted compared with 27% in patients with a DLCO of at least 70% predicted (sensitivity, 62%; specificity, 96%). However, technical morbidity was not related to preoperative lung function variables, including DLCO. Patients with a DLCO of at least 70% predicted had a low postpneumonectomy complication rate. Although cardiac arrhythmia was the major cause of morbidity, pulmonary edema was the major cause of mortality.     

Pulmonary resection after lung transplantation in cystic fibrosis patients

Pulmonary resection after lung transplantation in end-stage cystic fibrosis presents unique challenges, and scant literature exists to guide physicians. We retrospectively reviewed 78 transplants for cystic fibrosis performed between 2003 and 2008. Fourteen patients underwent posttransplantation pulmonary resection. We analyzed the indications, surgical procedures, outcomes, and survival. Three pneumonectomies, 4 lobectomies, and 11 wedge resections were carried out. We identified 2 groups based on indication: a diagnostic group, and a therapeutic group of patients in whom the indications were septic native lung in 2, allograft infection in 2, lobar torsion in 2, pulmonary infarction in 2, and size mismatch in 4. The mean intensive care unit and hospital stays were 29 and 50 days, respectively. Four (28.57%) patients died during follow-up, including 2 who underwent pneumonectomy; 10 (71.43%) are still alive. Survival was 43.43 ± 8.06 months, and it was not significantly different from that in cystic fibrosis patients who had lung transplantation without pulmonary resection. Pulmonary resection following lung transplantation in cystic fibrosis patients showed acceptable survival and surgical risk, but metachronous pneumonectomy was associated with higher mortality.     

单侧肺全切除术治疗单侧结核性全肺毁损48例分析

目的总结结核性单侧全肺毁损的外科治疗经验。 方法对48单侧结核性全肺毁损患者行全肺切除术,回顾性分析临床资料。结果48例中胸膜外全肺切除36例,术中出血500～5300ml,术后近期并发症12例（25%）：急性肺水肿3例,呼吸衰竭4例,脓胸3例,纵隔摆动2例,远期并发症为1例（2.1%）缩窄性心包炎;治愈45例（93.8%）;死亡2例（4.2%）。结论对单侧结核性全肺毁损患者,如果持续排菌或有明显症状,其心肺功能能代偿,应积极进行手术治疗,效果较满意。