Surgery for Pulmonary Aspergilloma and Pleural Aspergillosis
Surgery for Pulmonary Aspergilloma and Pleural Aspergillosis
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肺曲菌瘤和胸膜曲菌病的手术
DOI：
10.1055/s-2007-1022981
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
D. Greschuchna
中科院分区：
文献类型：
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作者：
G. Stamatis;D. Greschuchna
肺曲霉瘤和胸膜曲霉病是一种潜在的危及生命的疾病，由无处不在的真菌烟曲霉在肺或胸膜腔中定植引起。1976年至1986年间，24例肺曲菌瘤患者和5例胸膜曲菌病患者在我院接受了主要的胸部手术。14例患者有咯血，9例复发，5例危及生命。肺结核、肺炎和结节病是最常见的肺部病变。手术包括7例胸膜肺切除术，18例肺叶切除术和4例楔形切除术。术后死亡率约7%（2例）。经病理检查，4例患者除曲菌瘤外，还意外发现支气管癌。支气管胸膜瘘伴持续性空气间隙是仅在胸膜全肺切除术后才出现的严重并发症。包括曲菌肿和胸膜感染在内的23例患者无术后并发症；27例手术幸存者在随访1 - 10年期间均无复发症状。有记录的高风险曲菌瘤患者，即使无症状，也应切除，因为有出血的危险。对于胸膜曲霉病患者，只有积极切除才能提供有效的长期缓解。
Pulmonary aspergilloma and pleural aspergillosis are a potentially lifethreatening disease resulting from the colonization of lung or pleural cavities by the ubiquitous fungus Aspergillus fumigatus. Twenty four patients with pulmonary aspergilloma and five with pleural aspergillosis underwent major thoracic procedures at our hospital between 1976 and 1986. Fourteen of the patients had haemoptysis, in 9 it was recurrent, and in 5 life-threatening. Tuberculosis, pneumonia, and sarcoidosis were the most common preexisting lung lesions. Surgical procedures included 7 pleuropneumonectomies, 18 lobectomies and 4 wedge resections. The postoperative mortality rate was approximately 7% (2 pat.). Based on the pathological examination 4 patients had unexpectedly a bronchial carcinoma in addition to the aspergilloma. Bronchopleural fistula with persistent air space was a serious complication only for patients after pleuropneumonectomy. 23 patients including those with complex aspergilloma and pleural infection had no postoperative complications; in none of the 27 operative survivors were there any recurrent symptoms over a follow-up between one and ten years. Good-risk patients with documented aspergilloma, even asymptomatic, should be resected, because of the danger of exsanginating haemorrhage. For patients with pleural aspergillosis only the aggressive resection can provide effective long term palliation.