外科手术治疗肺曲菌病临床疗效分析

Clinical analysis of the efficacy of surgical treatment of pulmonary aspergillosis

目的探讨肺曲菌病的临床诊断及外科手术治疗肺曲菌病的临床疗效。方法对1997年1月～2012年1月经手术病理证实的21例肺曲菌病患者的诊断情况及手术结果进行分析。21例肺曲菌痛患者中术前明确诊断5例（23．8％），术前误诊为肺结核、肺部占位病变、肺囊肿或肺脓肿等16例（76．2％）。全组行肺叶切除术13例，肺段或肺楔形切除术8例。结果无住院死亡。术后出现胸腔积液3例，切口感染l例，肺不张2例，均经相应处理治愈。术后除常规治疗外，均给予氟康唑400mg／d，治疗4～8周。所有患者均得到随访，随访时间6个月～12年，肺曲菌病未复发，患者生活质量良好。结论肺曲菌病误诊、漏诊率高，需加强对肺曲菌病的认识，术前应认真检查以作出正确诊断；手术切除病变是治疗肺曲菌病的有效方法。

Objective To investigate the clinical diagnosis of pulmonary aspergillosis clinical efficacy and surgical treatment of pulmonary aspergillosis. Methods 21 cases of pulmonary aspergillosis patients were analyzed. 5 patients were diagnosed before operation, was made in 16 patients. A wrong diagnosed to tuberculosis, total or partial collapse of the lung or pulmonary cyst. Lobectomy was done in 13 patients. Segmentectomy or wedge resection was done in 8 patients. Results No death occurred during hospitalization. 3 patients had pleural effusion, 1 had incision infection and 2 patients had atelectasis. All of them recovered eventually. Fluconazol 400mg/d was given 4-8 weeks except for standard treatment. Following-up of all the patients were done after discharged from the hospital. Nobody recovered. Conclusion The correct diagnosis of the pulmonary aspergillosis should be made and wrong diagnosis must be avoided. Operative resection of pulmonary lesion is the treatment of choice.