외과적으로 치료한 폐국균종증의 임상분석 = Clinical Analysis of Surgically Treated Pulmonary Aspergilloma

다국어 초록 (Multilingual Abstract)

Background: Pulmonary aspergillosis usually results from the colonization in the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life threatening disease causing massive hemoptysis. Here we reviewed our surgical results for 45 cases of pulmonary aspergillonias. Methods： We reviewed 45 cases which were surgically treated from 1986 to 2003 retrospectively. This investigation were designed to illustrate distribution of age and sex, symptom and sign, underlying disease, anatomic location of lesion, roentgenographic findings of aspergilloma, surgical indication and operative procedures, postoperative complications. Results: Peak incidence of age lies 4th and 5th decades. Most common presenting symptom was hemoptysis (77.3%)，and pulmonary tuberculosis (24 cases) was the most common underlying disease. The anatomic location of lesions were 23 cases in right side，21 cases in left side，and 1 case in both side and more in upper lobes(32 cases) than in lower lobe (14 cases乂 The most common chest roentgenographic finding was cavity with fungal ball in 30 cases and simple aspergilloma in 29 cases，complex aspergilloma in 17 cases according to roentgenographic classification by Belcher and Plummer. The performed operative procedures were lobectomy (conventional and video assisted thoracic surgery) in 33 cases, segmentectomy in 3 cases, pneumonectomy in 3 cases， wedge resection in 3 cases, cavernostomy with myoplasty in 3 cases, and bilobectomy in 1 case. There were 20 complications, empyema with bronchopleural fistula in 7 cases, wound infection in 7 cases, prolonged air-leakage in 2 cases, reoperation due to massive hemorrhage in 2 cases，recurred aspergilloma during follow-up in one case and postoperative death due to acute respiratory distress syndrome in 1 case. Conclusion： Surgical resection is the treatment of choice for symptomatic aspergilloma with acceptable complications, even though it has only minimal hemoptysis.