肺曲菌球患者的外科治疗效果  

Surgical Treatment of Patients with Pulmonary Aspergillus

作　　者：兰峻斌 高毅哲 高木火 陈伦华 吴艺根 许胜水 李占清 段明科 LAN Junbin;GAO Yizhe;GAO Muhuo;CHEN Lunhua;WU Yigen;XU Shengshui;LI Zhanqing;DUAN Mingke(Department of Thoracic Surgery,Xiamen Haicang Hospital,Xiamen 361020,China;Department of Thoracic Surgery,The Second and Affi liated Hopsital of Xiamen Medical College,Xiamen 361020,China)

机构地区：[1]厦门市海沧医院胸外科,福建厦门361020 [2]厦门学医院附属第二医院胸心外科,福建厦门361020

出　　处：《中国医药指南》2020年第28期16-18,共3页Guide of China Medicine

摘　　要：目的分析肺曲菌球的诊断、治疗方法及并发症的预防。方法回顾性分析2005年1月至2017年12月于厦门学医院附属第二医院胸心外科接受手术治疗的39例肺曲菌球患者的临床资料。其中男28例,女11例,年龄22~69岁;结核空洞合并曲菌球21例,结核性毁损肺合并曲菌球7例,多囊肺合并曲菌球7例。结果其中行肺叶切除术28例,复合肺叶切除术6例(肺叶+肺部分切除术3例,右肺上+中叶切除术2例,左肺下叶+舌段切除术1例),全肺切除术4例,病灶清除+脓腔引流1例。全组无因手术死亡病例,8例(20.51%)发生术后并发症,包括肺复张不全3例,肺部感染2例,术后大出血1例,支气管胸膜瘘1例,切口感染1例,其中2例非计划二次开胸手术治疗并发症。术后随访1~12年,均无咯血或血痰、复发和病死情况发生。结论外科手术切除是治疗肺曲菌球患者的首选方法,对单纯型肺曲菌球可选用胸腔镜微创手术治疗。加强围手术期护理,将最大限度地降低肺曲菌球手术的并发症发生率。Objective To analyze the diagnosis and surgical management of pulmonary aspergilloma.Methods A retrospective analysis of the clinical data of 39 patients with pulmonary aspergilloma who underwent surgical treatment in the Department of Thoracic and Cardiac Surgery of the Second and Affiliated Hopsital of Xiamen Medical College from January 2005 to December 2017.There were 28 males and 11 females,and the age ranged from 22 to 69 years old.The associated diseases or conditions were tuberculosis empty in 21 patients,tuberculosis destroyed lung in 7 cases,multicystic pulmonary in 7 patients.Results The surgical procedures were 28 lobectomies,combined lobectomy 4,2 right upper and middle lobectomies,1 radical debridement and drainage,4 pneumonectomy.There was no periopertive mortality.Eight postoperative complications developed in this series(20.51%),including 3 pulmonary re-expansion insuffi ciency,2 pulmonary infections,1 postoperative bleeding,1 bronchial fi stula,1 wound infection.Two cases of unplanned secondary thoracotomy were treated for complications.There were no cases of hemoptysis or blood sputum,recurrence,and death in the follow-up for 1-12 years.Conclusion Surgical resection of pulmonary lesion is the most eff ective method for pulmonary aspergilloma,and meanwhile strengthening the perioperative management could decrease the morbidity and mortality.

关 键 词：肺曲菌球 外科手术 胸腔镜手术 并发症 

分 类 号：R512.62[医药卫生—内科学]