肺麴菌症的支氣管動脈攝影評估及外科治療

Bronchial Apteriographic Evaluation and Surgical Treatment of Pulmonary Aspergillosis

林建智(Chien-Chi Lin) ； 高英隆(Eing-Long Kao)

《The Kaohsiung Journal of Medical Sciences》 4卷8期 (1988/08) Pp. 436-443

https://doi.org/10.6452/KJMS.198808.0436

摘要

本文為十年來高雄醫學院以外科手術治療肺麴菌症的經驗報告。雖然幾乎全部的病例均因咳血而具挑戰性，然而由於十例中的六例，在手術前即以支氣管動脈攝得知病變部位的血管變化。如血管增生(六例)，支氣管動脈肺動脈吻合(二例)，血液外滲(二例)及側枝循環（四例）。因此得有良好術前評估。此外大量咳血的二例更在動脈栓塞下，有效地控制住咳血而能進行手術。十例之中包括男性三例，女性七例。年齡平均為37歲。合併的相關疾病以肺疾患(8例／10例)，如肺結核，支氣管擴張症居多。胸部X光的表現：四例為支氣管擴張症，四例有ball-in-hole,一例為肺內囊，一例無特殊變。
我們採的手術方依病灶範圍而有全肺、肺葉或肺節切除等不同。手術後，兩因呼吸衰竭、一例因肺動脈畸型出血死亡。其他七例經長期追蹤，肺功能亦有進步。至於咳痰或咳血症狀則完全消失。一例於六年因突發性咳血亡一例三年因食道靜脈瘤出血死亡。

並列摘要

This report is of ten cases experience in bronchial arteriographic evaluation and surgical treatment of pulmonary aspergillosis at Kaohsiung Medical College Hospital from January 1978 to June 1988.
Although hemoptysis was a big challenge in the surgical treatment of pulmonary aspergillosis, angiographic study did however vastly benefit the preoperative evaluation by increasing the understanding of the vascular changes of the lesion. Bronchial arterial embolization also made massive hemoptic patients become operable.
All of the cases were pathologically proven to be aspergillosis. Reasons for surgical management were hemoptysis (nine cases) and one refractory cough. Sex distributions were three males and seven females, and their mean age was 37 years old. Besides diabetes mellitus and liver cirrhosis, the following pulmonary disorders were dominantly found as the underlying disease in this series, such as tuberculosis, bronchiectasis and intrapulmonary cyst. Roentgenologically, four cases with bronchiectasis, four ball-in-hole, one intrapulmonary cyst and one nonspecific finding were observed. Bronchial angiography was performed in six patients. All of them were found with apparent changes of hypervascularization (6 cases), bronchopulmonary anastomosis (2 cases) and extravasation (2 cases) indicating a chronicinflammatory process. Bronchial arterial embolization was successfully held in two massive hemoptic patients so that the surgical resection became tolerable.
According to the involvement of the lesions, pneumonectomy (1 case), bi-lobectomy (1 case), lobectomy (7 cases) and segmentectomy (1 case) were performed. Postoperatively, two cases died of respiratory failure and one case died of the rebleeding of the pulmonary arterio-venous malformation. The long term follow-up for another seven cases revealed good result with improvement in lung function and cessation of hemoptysis.

並列關鍵字

hemoptysis ； pulmonary aspergillosis ； bronchial arterial embolization