肺部真菌病51例的诊断与外科治疗

Diagnosis and surgical treatment of 51 cases of lung mycosis

目的总结51例肺真菌病患者的临床特点、诊断和外科治疗经验。方法回顾分析1981-2008年解放军总医院胸外科收治的51例肺真菌病患者的临床资料。结果本组肺真菌病患者包括白念珠菌3例，曲霉菌22例，隐球菌26例。其临床症状包括咳嗽、咯血、发热、胸闷、胸痛和哮喘，但有20例为常规体格检查发现病灶。胸部x线片和CT检查中，29例表现为肺内实质性结节，部分有毛刺、棘突；13例表现为肺空洞，壁厚均一，内壁较光滑，其中7例见曲菌球。行标准剖胸手术48例，行胸腔镜或胸腔镜辅助小切口手术3例；肺叶切除17例，局部楔形切除34例。本组病例无手术死亡，且均经术后病理证实，随访3～10年无复发。结论原发性肺真菌病的临床表现和影像学检查缺乏特征性表现，病理检查为确诊依据，手术是诊断及治疗本病的一种较有效的方法。

Objective To summarize the clinical characteristics, diagnosis and surgical management experiences of 51 cases of pulmonary fungal infections. Methods The clinical data of 51 pulmonary fungal infection patients hospitalized in department of thoracic surgery of PL General Hospital from 1981 to 2008 were retrospectively analyzed. Results The recruited cases included three cases of Candida albicans, 22 of Aspergillus, and 26 of Cryptococcus. The clinical symptoms included cough, hemoptysis, fever, chest tightness, chest pain and asthma. Twenty cases were identified through routine healthy examination. Of chest X-ray and computed tomograply scan, 29 cases presented with solid nodules in the lung, some of which had burrs and spikes; 13 presented with puhnonary cavity with even wall thickness and smooth inner wall including 7 with aspergillar glomera. Forty-eight cases underwent standard thoracotomy operations and 3 cases underwent thoracoscope or thoracoscopy-assisted minithoracotomy. Seventeen underwent pulmonary lobectomies, and 34 wedge resections. There was no operative mortality in the 51 patients. All diagnoses were confirmed by postoperative pathology. There was no relapse during 3--10 years of follow up. Conclusions Primary pulmonary fungal infections lack characteristic presentations in clinical manifestations and imaging examinations. Pathology is the evidence for definite diagnosis. Surgical intervention is an effective tool for diagnose and treatment of this disease.