肺曲菌球病胸腔镜手术治疗195例临床分析

Clinical analysis of thoracoscopic surgery for pulmonary aspergilloma disease：a report of 195 cases

目的探讨肺曲菌球病的胸腔镜手术治疗临床疗效及并发症。方法回顾性分析我院胸外科胸腔镜手术治疗肺曲菌球病共195例临床资料，单纯性肺曲菌球病89例，复合性肺曲菌球病106例。全部在完全胸腔镜（VATS）或胸腔镜辅助小切口（VAMT）下完成手术。结果治愈191例，治愈率97．9％，无手术死亡，术后发生并发症54例，包括出血、心律失常、肺部感染、肺漏气复张不全、支气管胸膜瘘、弥漫性血管内凝血、切口感染等。结论外科手术为曲菌球病首选的确切有效治疗方法。对于肺部病变局限、胸膜粘连轻、高龄、体质差的患者，胸腔镜手术治疗具有微创、并发症少的巨大优势。早诊断早手术治疗，有利于减少手术时间、术中出血量及术后并发症。

Objective To investigate the clinical effect and postoperative complications of thora- coscopic surgery for pulmonary aspergilloma disease. Methods The clinical data of 195 cases of pulmona- ry aspergilloma disease who underwent thoracoscopic surgery were analyzed retrospectively, including 89 cases of simple pulmonary aspergilloma disease and 106 cases of complex pulmonary aspergilloma disease. All the operation were completed by VATS（ video-assisted thoracoscopic surgery）or VAMT（ video-assisted minithoracotomy）. Results One hundred and ninety-one cases had been cured with a cure rate of 97.9%. No postoperative deaths occurred. There were postoperative complications in 54 patients, including haemorrhage, arrhythmia, lung infection, air leak, bronchopleural fistula, disseminated intravascular coagu- lation and wound infection. Conclusion In the treatment of pulmonary aspergilloma disease, surgical op- eration is the primary choice for its precision and effectiveness. The thoracoscopic surgery is particularly suitable for weak and aged patients with less pleural adhesion and limited lesions because of the huge ad- vantages of minimal invasion and few complications. Early diagnose and surgical treatment were conducive to minimize blood loss, operation time and postoperative complications.