56例肺及胸膜残腔曲菌病的诊断和手术治疗

目的 总结肺及胸膜残腔曲菌病的诊断和手术治疗经验。方法 对1972年9月至2003年6月我科诊治的56例肺曲菌病及胸膜残腔曲菌病患者的临床资料进行回顾性分析。本组肺曲菌病53例,胸膜残腔曲菌病3例。所有病例均行胸片或肺CT检查并行手术治疗,其中8例在术前经痰培养(5例)或肺组织穿刺活检(2例)或纤维支气管镜活检(1例)获得病原学诊断。53例肺曲菌病中,42例行肺叶切除术,3例行肺段切除术,8例行肺楔形切除术;3例胸膜残腔曲菌病在清除病灶后,2例行胸廓成形术,另1例延长胸腔闭式引流时间,并在残腔内反复注入氟康唑治疗1个月(每次200mg、100ml,1次／2～3d)。结果 全组患者均治愈,无手术死亡。术后随访无复发病例。结论 对肺及胸膜残腔曲菌病应采取积极的手术治疗,手术治疗效果较好。

The diagnosis and surgical treatment for 56 cases with pulmonary and pleural aspergillosis

Objective To summarize the experience of diagnosis and surgical treatment for pulmonary and pleural aspergillosis. Methods The clinical data of cases with pulmonary and pleural aspergillosis were analyzed retrospectively between September 1972 and June 2003.There were 53 cases with pulmonary aspergillosis and 3 cases with pleural aspergillosis.Aspergillus was found preoperatively in 8 patients by sputum culture(5 cases) or needle biopsy of the lung(2 cases) or fibrobronchoscopic biopsy(1 case).All patients were treated with surgical procedures following X-ray film or CT scan. Results Of 53 cases with pulmonary aspergillosis,42 lobectomies,3 segmentectomies,and 8 wedge resections were performed.Of three cases with pleuralaspergillosis following eliminating their diseased foci in residual pleural space,two underwent thoracoplasty,one underwent postoperative closed chest drainage for one and an half month with fluconazole injected into residual pleural space repeatedly for 1 month(200mg/100ml,1 time per 2 or 3 days).No operative death and major postoperative complications occurred.None of the patients had recurrent symptoms at follow-up. Conclusion We recommend aggressive surgical resection for pulmonary and pleural aspergillosis,and the surgical result is excellent.