协和医学杂志

2014, v.5(03) 318-322

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34例肺曲霉菌病的外科治疗
Surgical Treatment for Pulmonary Aspergillosis: Report of 34 Cases

何嘉;陈野野;李单青;
HE Jia;CHEN Ye-ye;LI Shan-qing;Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的探讨外科手术治疗肺曲霉菌病的原则、方法及效果。方法回顾性分析北京协和医院1986年1月至2013年12月经手术治疗的34例肺曲霉菌病患者的临床资料及随访结果。3例CT表现为弥漫性病变的患者采用肺楔形切除术获得病理组织;31例局限性病变患者均行病变完整切除,其中肺叶切除术26例,肺段切除术3例,肺楔形切除术2例。27例行开胸手术,7例行胸腔镜手术。结果无手术死亡病例,所有病例均由病理诊断为曲霉菌感染。术后出现并发症的患者5例(14.7%),分别为肺栓塞1例,急性肺水肿1例,胸腔积液1例,支气管胸膜瘘1例,切口裂开1例。术后2~34 d出院,平均住院时间(10.1±6.2)d。随访1~16年,全部治愈,无复发。结论对于弥漫性肺部病变怀疑肺曲霉菌病无法明确诊断时,手术肺组织活检可提供病理及病原学诊断的金标准;对于局限性肺曲霉菌病变,外科手术可将病灶完整切除,提供明确的病理诊断,并有效缓解症状,避免复发。
Objective To summarize the principles,techniques,and effectiveness of the surgical treatment for pulmonary aspergillosis. Methods The clinical data of 34 pulmonary aspergillosis patients who had undergone surgical treatment in our department from January 1986 to December 2013 were retrospectively analyzed. Three patients with diffuse lesions manifested by CT image received wedge resection to obtain pathological tissues. Thirty-one patients with localized lesions received complete resection,in whom the surgical procedures included lobectomy( n = 26),segmentectomy( n = 3),and wedge resection( n = 2). Thoracotomy was performed in 27 patients and video-assisted thoracoscopic surgery in 7 patients. Results No perioperative death was noted. All the 34 patients were pathologically confirmed as with pulmonary aspergillosis. Five patients( 14. 7%) suffered from postoperative complications including pulmonary embolism( n = 1),acute pulmonary edema( n = 1),pleural effusion( n = 1),prolonged air leak( n = 1),and wound disruption( n = 1).All patients were successfully discharged 2- 34 days after the surgery,and the average hospital stay was( 10. 1 ±6. 2) days. No relapse was noted during the 1- 16 years of follow-up. Conclusions For patients with suspected pulmonary aspergillosis,which may present as diffuse lung lesions,surgical biopsy provides the "golden standard"of pathological and pathogenic diagnosis. For patients with localized pulmonary aspergillosis,surgicaltreatment can completely remove the lesions,provide definite pathological diagnosis,and effectively relieve the symptoms.

关键词(KeyWords): 肺曲霉菌病;胸外科手术
pulmonary aspergillosis;thoracic surgical procedures

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作者(Author): 何嘉;陈野野;李单青;
HE Jia;CHEN Ye-ye;LI Shan-qing;Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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