160例肺曲菌球的外科治疗

目的探讨肺曲菌球的手术适应证及减少术后并发症的方法。方法回顾分析我院1975年9月至2006年3月经外科手术治疗的160例肺曲菌球患者的临床资料,根据肺部基础病变的性质和程度分为单纯性肺曲菌球组(SPA,n=34)和复合性肺曲菌球组(CPA,n=126)。分别行肺切除术154例,胸廓改形术加肺叶切除或肌瓣充填术3例,曲菌球清除加肌瓣填塞术3例。结果无手术死亡,160例患者中治愈156例,治愈率97.5%。术后发生并发症44例(27.5%),其中肺炎15例,肺复张不全12例,持续漏气10例,脓胸5例,肺脓肿5例,支气管胸膜瘘3例,切口感染2例。SPA组术后并发症发生率低于CPA组(P<0.05)。术后随访151例,随访4个月~5年无复发。结论外科手术为治疗肺曲菌球的首选方法,客观可靠的术前评估是减少术后并发症和手术成败的关键。电视胸腔镜辅助小切口开胸手术具有创伤小、恢复快、术后并发症少的优点,适用于肺基础病变局限、胸膜粘连较轻的患者。

Surgical Treatment for Pulmonary Aspergilloma: A Report of 160 Cases

Objective To investigate the surgical indications of pulmonary aspergilloma,and to reduce postoperative complications.Methods A total of 160 surgically treated patients with pulmonary aspergilloma were analyzed retrospectively from September 1975 to March 2006.All patients were divided into two groups: simple pulmonary aspergilloma(SPA,n=34) and complex pulmonary aspergilloma(CPA,n=126),according to the nature and extent of the underlying disease of the lung.The operative procedures included 154 pulmonectomy,3 thoracoplasties with pulmonectomy or filling with the muscle flap,and 3 cavernostomy filling with the muscle flap.Results 156 of 160 cases had been cured with cure rate of 97.5% and no postoperative deaths.There were postoperative complications in 44 patients(27.5%) including: pneumonia(15 cases),incomplete reexpansion(12 cases),prolonged air leak(10 cases),empyema(5 cases),pulmonary abscess(5 cases),bronchopleural fistula(3 cases) and wound infection(2 cases).Postoperative complications of SPA group were lower than those in CPA group(P<0.05).One hundred and fifty-one patients were followed up for 4 months to 5 years,no recurrence were observed.Conclusion Surgical resection for pulmonary aspergilloma should be selected first whenever the diagnosis of aspergilloma is confirmed.Objective and reliable preoperative evaluation is the key to reducing postoperative complications and surgery success.Because of minimal invasiveness,short length of hospital stay and less postoperative complications,video-assisted minithoractomy surgery may be superior to open thoracotomy in patients with localized underlying pulmonary disease and less pleural adhesions.