原发性肺隐球菌病的外科治疗

目的 探讨原发性肺隐球菌病的临床特点、诊断与治疗。方法 回顾分析1996年-2004年解放军总医院胸外科收治的11例原发性肺隐球菌病患者的临床资料。结果 64％（7／11）的患者有全身或呼吸道症状。全部患者胸部X线片及胸部CT检查误诊为肺癌、肺炎或结核。3例行^18氟脱氧葡萄糖-正电子发射体层显像（FDG—PET）检查,均表现为高代谢病灶。全部患者抗炎与抗结核治疗后病变无变化。术前仅2例行超声引导下穿刺病理检查明确诊断,口服抗真菌药物治疗后病灶不能完全吸收。所有患者病变均手术切除,术后仅1例多发病变患者行抗真菌治疗。术后随访9～130个月（中位时间32个月）,均无复发。结论 原发性肺部隐球菌病的临床症状、化验检查、影像学表现均无特异性,病理检查为确诊的依据,治疗采用局部切除为宜,切除彻底术后可不行抗真菌治疗。

Surgical treatment of primary pulmonary cryptococcosis

Objective To assess the clinical feature,diagnosis and treatment of primary pulmonary cryptococcosis.Methods From 1996 to 2004,11 patients with primary pulmonary cryptococcosis were surgical treated and confirmed by histologic study.At the same period,2715 patients with pulmonary abnormalities received surgery.Their clinical data were retrospectively reviewed.Results Sixty-four percent(7/11) of the patients were symptomatic at the time of diagnosis.All 11 cases were misdiagnosed as lung cancer or inflammatory or tuberculosis by X-ray and CT scan before surgery.Three cases received fluorine-18 fluorodeoxyglucose-positron emission tomography(FDG-PET) scan and their primary pulmonary lesions showed FDG avid.All 11 patients were treated by antibiotics and antituberculosis therapy but no responses appeared.Primary pulmonary cryptococcosis was diagnosed by ultrasound-guided fine needle aspiration biopsy in only 2 cases,but antifungal therapy was not effective.All 11 patients underwent thoracotomy and their pulmonary cryptococcosis were resected.Only 1 patient with multiple nodules received antifungal therapy postoperatively.No recurrence was found in any patients.Conclusions Primary pulmonary cryptococcosis is non-specific and can be confused with lung cancer,tuberculosis,etc.The pulmonary abnormalities should be resected unless the diagnosis is established.Antifungal therapy is not necessary in patients whose abnormality has been resected thoroughly.