肺移植术后曲霉菌感染(附4例报告和文献复习)

Aspergillosis infection in lung transplant recipients (4 cases report and review of the literature)

目的探讨肺移植术后曲霉菌感染的预防、监测和治疗方法。方法2003年1月至2004年9月,6例重度肺气肿病人成功实行同种异体单肺移植术,其中4例术后痰培养发现曲霉菌。结果2例临床上无肺部感染症状,口服伊曲康唑治疗近2个月。1例术后1个月纤维支气管镜提示支气管吻合口局部侧壁软化、狭窄,被坏死组织覆盖,活检找到霉菌,置入镍钛网状支架后症状改善。另1例术后并发自体肺严重曲霉菌浸润性肺部感染,咳出桔红色痰,量最多达180ml/d。X线胸片提示有空洞表现,经伊曲康唑静脉注射和应用两性霉素B雾化吸入治疗6周后,症状消失、X线胸片空洞关闭而治愈。结论应用伊曲康唑和两性霉素B雾化吸入,对肺移植术后早期曲霉菌感染的预防和治疗都是有效的。

Objective To discuss the prophylaxis, surveillance, and therapy on the aspergillus colonization and infection in lung transplant recipients. Methods From Jan 2003 to Sep 2004, single lung transplantation was performed in 6 patients. In 4 patients there was presence of positive aspergillus cultures from sputum after operation. Results Of these, two patients were symptomless, though treated by Itraconazole for two months. The third one has symptomatic bronchial stenosis, bronchomalacia and saprophytic colonization in the first postowarative month, which was proved by bronchoscopic biopsy and cured by stenting. The last one with invasive, disseminated pneumonia duo to aspergillus was cured after six weeks by itraconazole and aerosolized amphoteficin B. Conclusion Antifungal prophylaxis with itraconazole and aerosolized amphoteficin B prevent fungal infection during the early postoperative period of lung transplantation.