Aggressive surgical management in localized pulmonary mycotic and nonmycotic infections for neutropenic patients with acute leukemia:: Report of eighteen cases
Aggressive surgical management in localized pulmonary mycotic and nonmycotic infections for neutropenic patients with acute leukemia:: Report of eighteen cases
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DOI：
10.1016/s0022-5223(98)70443-x
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发表时间：
1998-01-01
影响因子：
6
通讯作者：
Michaud, JL
中科院分区：
文献类型：
--
作者：
Baron, O;Guillaumé, B;Michaud, JL
目的：为预防局限性侵袭性肺曲霉病化疗后中性粒细胞减少患者咯血及复发，采用积极的手术治疗方法。从1988年到1996年，18例血液系统疾病患者被诊断为局限性侵袭性肺曲霉病，诊断依据是临床特征，抗生素治疗无效，计算机断层扫描显示曲霉病的空气新月形征象（39%），支气管肺泡灌洗取真菌（44%）。1例全肺切除术，4例胆管切除术，7例肺叶切除术，6例楔形切除术，1例肺叶楔形切除术（1例共2次手术），无围手术期死亡及并发症发生。12例患者经组织学检查确诊为侵袭性肺曲霉病，其余6例诊断如下：单因素分析显示，非侵袭性肺曲霉病组胸痛发生率（1/6）低于侵袭性肺曲霉病组（8/12）（p < 0.05）， 16例患者需要后续血液学治疗，66%的患者存活，平均随访29.1±27.8个月（2 ~ 103个月）。侵袭性与非侵袭性肺曲霉病组间差异无统计学意义，5例患者因恶性疾病复发死亡，平均17.2 +/- 12.5个月（2 ~ 30个月），1例患者在3个月后进行骨髓移植时发生脑曲霉感染复发。积极的手术治疗从根本上改善了侵袭性肺曲霉病的预后，即使手术指征包括一些非真菌感染，因为难以建立临床诊断。
Objective: To prevent hemoptysis and relapse during subsequent chemotherapy-induced neutropenia in patients with localized forms of invasive pulmonary aspergillosis, rye adopted an aggressive surgical approach, Methods: From 1988 to 1996, 18 patients with hematologic diseases were referred with the diagnosis of localized invasive pulmonary aspergillosis, The diagnosis was based on clinical features, failure to respond to antibiotic therapy, an air crescent sign suggestive of aspergillosis on the computed tomographic scan (39%), and retrieval of fungi by bronchoalveolar lavage (44%), Results: The following procedures were done: one pneumonectomy, four bilobectomies, seven lobectomies, six wedge resections, and one lobectomy with wedge resection (one patient had two procedures), No perioperative deaths or complications occurred, The histologic examination confirmed the diagnosis of invasive pulmonary aspergillosis in 12 patients, The six other diagnoses were as follows: one case of classic aspergilloma, one case of pneumonia, and four cases of pulmonary abscess, According to univariate analysis, thoracic pain was less common in the group with noninvasive pulmonary aspergillosis (1/6) than in the group with invasive pulmonary aspergillosis (8/12) (p < 0.05), Sixteen patients required subsequent hematologic treatments, Sixty-six percent of the patients are alive with a mean follow-up of 29.1 +/- 27.8 months (range 2 to 103 months), with no statistically significant difference between the invasive and the noninvasive pulmonary aspergillosis groups, Five patients died of a recurrence of their malignant disease at a mean of 17.2 +/- 12.5 months (range 2 to 30 months), and one had a cerebral recurrence of Aspergillus infection during a bone marrow transplantation 3 months later, Conclusion: Aggressive surgical management radically improves the prognosis of invasive pulmonary aspergillosis, even if the surgical indications include some nonmycotic infections because of the difficulty in establishing the clinical diagnosis.