血液系统肿瘤患者侵袭性肺部真菌感染的外科手术治疗

中国真菌学杂志　 2010, Vol. 5 　Issue (2): 69-73.

血液系统肿瘤患者侵袭性肺部真菌感染的外科手术治疗

唐菲菲, 许兰平, 刘代红, 刘开彦, 陈欢, 韩伟, 张晓辉, 陈育红, 王峰蓉, 王昱, 黄晓军

北京大学人民医院, 北京大学血液病研究所, 北京, 100044

收稿日期:2010-02-01 出版日期:2010-04-28 发布日期:2010-04-28
通讯作者: 黄晓军,E-mail:xjhrm@medmail.com.cn E-mail:xjhrm@medmail.com.cn
作者简介:唐菲菲,女(汉族),博士,住院医师.E-mail:bjmugirl@163.com
基金资助:
卫生部公益行业科研专项经费项目(200802027);教育部创新团队发展计划(IRT0702)

Surgical management of invasive pulmonary fungal infection in patients with hematologic diseases

TANG Fei-fei, XU Lan-ping, LIU Dai-hong, LIU Kai-yan, CHEN Huan, HAN Wei, ZHANG Xiao-hui, CHEN Yu-hong, WANG Feng-rong, WANG Yu, HUANG Xiao-jun

Peking University People’s Hospital & Peking University Institute of Hematology, Beijing 100044, China

Received:2010-02-01 Online:2010-04-28 Published:2010-04-28

摘要/Abstract

摘要： 目的探讨怀疑肺部有侵袭性真菌感染(invasive fungal infection,IFI)的血液恶性肿瘤患者行手术切除肺部病灶的安全性及有效性。方法分析2005年4月～2009年7月之间因血液系统肿瘤合并疑似侵袭性肺部真菌感染而接受肺切除术的10名患者,总结术后并发症及死亡率来探讨手术的有效性和安全性。结果手术均在全身麻醉下进行,5例为胸廓切开术,5例为胸腔镜下手术。3例为病灶楔形切除术,7例为肺叶切除术。术后组织病理:确诊真菌感染6例(60%),慢性细菌感染1例,3例未见明确病原菌。术后4例出现并发症:3例为轻度并发症(30%),其中2例气胸后自行吸收,1例局限性肺不张;1例严重并发症为血胸(10%)。术后30d死亡率为10%。术后真菌复发率为16%。随访至2009年8月31日,中位随访时间为3.8个月(0.7～31.1个月),4例(40%)死亡,但手术相关死亡率为0%。结论手术切除不仅有助于明确诊断而且还可以清除病灶、防止IFI复发和允许进一步的免疫抑制治疗,手术本身是安全的。

关键词: 侵袭性肺部真菌感染, 肺切除术, 血液系统肿瘤

Abstract: Objective To investigate the efficacy and safety of surgical management in patients with hematology malignancies and suspected invasive pulmonary fungal infections.Methods A total of 10 patients with hematologic malignancies suspected of invasive pulmonary fungal infection and underwent pulmonary resection from April 2005 to June 2009 were recruited and analyzed.Postoperative complications and mortality were summarized to evaluate the efficiency and safty of surgery.Results All the surgery were performed under general anesthesia,including 5 thoracotomy surgery and 5 video-assisted thorascopic surgery.Three had wedge resections while seven had lobectomies.Postoperative histopathology proved invasive pulmonary fungal infection in 6 patients (60%),chronic bacterial infection in 1 patients.Postoperative complications occurred in 4 patients (40%),including pneumothorax (n=2) that absorded by itself,localized respiratory insufficiency (n=1),and hemothorax in 1 patients.Postoperative mortality within 30 d was 10%,while postoperative pulmonary IFI relapse rate was 16%.Until 31 August 2009,4 (40%) patients died with the mean follow-up period of 3.8 months (0.7-31.1 months).Conclusions Surgery is safe and helpful for diagnosis,lesion removement,prevention of IFI relapse and further immunosuppressive treatment.

Key words: invasive pulmanory fungal infection, surgey (IPFI), lung resection, hematologic malignancies

中图分类号:

R756.6

唐菲菲, 许兰平, 刘代红, 刘开彦, 陈欢, 韩伟, 张晓辉, 陈育红, 王峰蓉, 王昱, 黄晓军. 血液系统肿瘤患者侵袭性肺部真菌感染的外科手术治疗[J]. 中国真菌学杂志, 2010, 5(2): 69-73.

TANG Fei-fei, XU Lan-ping, LIU Dai-hong, LIU Kai-yan, CHEN Huan, HAN Wei, ZHANG Xiao-hui, CHEN Yu-hong, WANG Feng-rong, WANG Yu, HUANG Xiao-jun. Surgical management of invasive pulmonary fungal infection in patients with hematologic diseases[J]. Chinese Journal of Mycology, 2010, 5(2): 69-73.

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