孤立性肺部真菌感染治疗体会

The Treatment Experience of Solitary Pulmonary Fungal Infection

目的探讨孤立性肺部真菌感染临床特点、诊断、手术治疗、对比术后是否使用抗真菌药物治疗及疗效.方法回顾分析2004年1月至2014年10月广西医科大学附属肿瘤医院19例肺孤立性真菌感染病例的临床资料,其中肺隐球菌病5例、肺曲霉菌病13例、肺念珠菌病1例.肺楔形切除术7例,肺叶切除术12例.术后10例患者使用抗真菌药物治疗,9例未使用抗真菌药物治疗.观察疗效并定期随访.结果于术前误诊14例,19例均完全切除病灶.无手术死亡病例,术后无切口感染,无脓胸以及支气管胸膜瘘等.术后随访1～72个月,19例均治愈无复发.术后使用抗真菌药物治疗组与未使用抗真菌药物治疗组疗效差异无统计学意义（P〉0.05）.结论孤立性肺真菌感染术前难以明确诊断,手术治疗可彻底切除病灶并明确诊断,治疗效果及预后佳.对于已完整切除的肺孤立性真菌感染病例,不一定需要行规范抗真菌治疗.

Objective To study the clinical manifestation, diagnosis, surgery and post operation treatment of solitary pulmonary fungal infection. Methods We retrospectively analyzed 19 cases of solitary pulmonary fungal infection in guangxi tumor hospital from January, 2004 to October, 2014. There were 5 cryptococcus infected patients, 13 aspergillus infected and 1 candida infected. Of all the patients, 7 underwent pulmonary wedge resection, 12 underwent pulmonary lobeetomy. After surgical treatment, 10 patients underwent antifungal drugs treatment and 9 didn＇t, Results 14 cases was misdiagnosed before operation. All cases received successful surgical treatment and none of them had complications. The 19 patients were followed up for 1 to 72 months, and all of them were cured. There was no significant difference between the patients received antifungal drugs treatment and none （P〈0.05） . Conclusions Solitary pulmonary fungal infection is hard to diagnose. Surgical treatment can remove nodule absolutely. Surgical treatment is a better way to choose. It is not necessary to receive antifungal drugs treatment for those patients who have been removed nidus successfully.