全肺切除术在肺毛霉菌病治疗中的价值  

The value of pneumonectomy in the treatment of pulmonary mucormycosis

作　　者：朱建坤[1] 孟倩 孔康宝 金锋 Zhu Jiankun;Meng Qian;Kong Kangbao;Jin Feng(Department of Thoracic Surgery,Shandong Provincial Public Health Clinical Center,Shandong University,Ji’nan 250100,China;Department of Pediatrics,the Third Affiliated Hospital of Shandong First Medical University,Ji’nan 250031,China)

机构地区：[1]山东大学附属山东省公共卫生临床中心胸外科,济南250100 [2]山东第一医科大学第三附属医院儿科,济南250031

出　　处：《中国防痨杂志》2025年第3期274-281,共8页Chinese Journal of Antituberculosis

基　　金：山东省医药卫生科技发展计划项目(202104020663)。

摘　　要：目的:通过复习相关文献,探讨全肺切除术在肺毛霉菌病治疗中的价值。方法:以“肺毛霉菌”“肺切除术”“Mucormycosis”“Pneumonectomy”为检索词,通过中国知网及PubMed数据库进行检索,检索时间为2004—2024年,共检索出10例患者通过全肺切除术治疗肺毛霉菌病。本研究总结10例患者的特点,并对肺切除术在肺毛霉菌病治疗中的适应证及疗效进行分析。结果:10例患者感染程度均属于深度感染,有1例出现余肺播散感染迹象,10例患者中有8例术后病理查到肺动脉受侵,其中2例形成肺动脉假性动脉瘤。9例患者查到主支气管受侵,其中1例累及隆突,1例出现主支气管胸膜瘘。10例患者中,6例合并糖尿病,术后4例获得长期治愈,2例在围手术期间死亡。有3例患者合并血液系统疾病,1例患者既合并血液系统疾病又合并糖尿病,均于随访过程中死于血液系统疾病及相关并发症。结论:肺毛霉菌病具有快速进展和侵犯大血管及中心气道的特性。当出现深度感染、累及肺动脉干及分支、侵犯主支气管等情况时,可作为实施全肺切除术的适应证。应积极控制基础病,联合抗真菌药物治疗及术后加强监护,可减少术后并发症的发生。Objective:To explore the value of pneumonectomy in the treatment of pulmonary mucormycosis by reviewing relevant literature.Methods:A total of 10 patients were found having pulmonary mucormycosis treated with pneumonectomy through searching CNKI and PubMed database from 2004 to 2024.This study summarized characteristics of these 10 patients and analyzed indications and effectiveness of pneumonectomy in the treatment of pulmonary mucormycosis.Results:All 10 patients were deeply infected,1 case showed signs of disseminated infection in the remaining lungs,8 out of the 10 patients had pulmonary artery invasion proved by postoperative pathological test,and 2 of them formed pulmonary artery pseudoaneurysm.Nine patients were found having main bronchial invasion,one of them involved carina,and one case had an astrobnopleural fistula.Among the 10 patients,6 had diabetes mellitus,among whom 4 got long-term cure after surgery and 2 died during perioperative period.There were 3 patients with hematologic diseases and 1 patient with both hematologic diseases and diabetes mellitus,all of them died of hematologic diseases and related complications during the follow-up.Conclusion:Pulmonary mucormycosis has the characteristics of rapid progression and invasion of large vessels and central airways.In the presence of deep infection,involving pulmonary artery trunk and branches,invading main bronchus,etc.,it can be used as indication for pneumonectomy.The underlying disease should be actively controlled,combined with antifungal drug therapy and intensive postoperative monitoring,which can reduce the occurrence of postoperative complications.

关 键 词：肺 毛霉菌病 肺切除术 治疗应用 

分 类 号：R563[医药卫生—呼吸系统] R61[医药卫生—内科学] R81[医药卫生—临床医学]