SURGICAL-MANAGEMENT OF INVASIVE PULMONARY ASPERGILLOSIS IN IMMUNOCOMPROMISED PATIENTS

被引：56

作者：

WONG, K

WATERS, CM

WALESBY, RK

机构：

[1] University Department of Surgery, The Royal Free Hospital, London

[2] Department of Cardiothoracic Surgery, The London Chest Hospital, London

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1992年 / 6卷 / 03期

关键词：

INVASIVE PULMONARY ASPERGILLOSIS; SURGICAL MANAGEMENT; IMMUNOCOMPROMISED BONE MARROW TRANSPLANTATION; HEMOPTYSIS;

D O I：

10.1016/1010-7940(92)90119-I

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The treatment of haematological malignancies with intensive chemotherapy and bone marrow transplantation results in prolonged periods of immunosuppression. This is associated with an increased incidence of invasive pulmonary aspergillosis (IPA) with reported mortalities of 67-83%. The mainstay of treatment is medical therapy, surgery being reserved for patients with haemoptysis. Resection of focal sites of infection has not been routinely considered in view of the high morbidity and mortality reported from the surgery of aspergillomas in past series. After the death of two neutropenic patients from massive haemoptysis following IPA in 1986, we have resected localised pulmonary aspergillus lesions in 16 patients following IPA. Five patients had haemoptysis. The most common procedure performed was a lobectomy. All patients were granulocytopenic and excessive post-operative bleeding occurred in three patients, one of whom required a re-thoracotomy as a result. There was one post-operative death due to cytomegalovirus pneumonia. Surgery was otherwise uneventful. There were no recurrent pulmonary aspergillus infections on follow-up and three patients proceeded to bone marrow transplantation. The success of surgical resection encourages an aggressive policy in the management of IPA to prevent life-threatening haemoptysis and to allow patients to proceed with further chemotherapy and bone marrow transplantation.

引用

页码：138 / 143

页数：6

共 23 条

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