Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Pulmonary Resection for Invasive Pulmonary Aspergillosis in Hematological Malignancy Patients

혈액암 환자에서 합병된 침습성 폐아스페르길루스증의 수술적 치료

  • Sa, Young-Jo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Catholic University College of Medicine) ;
  • Kim, Yong-Han (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Catholic University College of Medicine) ;
  • Nam, Sang-Yong (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Catholic University College of Medicine) ;
  • Sim, Sung-Bo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Catholic University College of Medicine) ;
  • Lee, Sun-Hee (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Catholic University College of Medicine) ;
  • Park, Jae-Kil (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, Catholic University College of Medicine)
  • 사영조 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 김용한 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 남상용 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 심성보 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 이선희 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 박재길 (가톨릭대학교 의과대학 성모병원 흉부외과학교실)
  • Published : 2007.09.05
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Abstract

Background: Invasive pulmonary aspergillosis, a frequent fungal infection in immunocompromised patients, is known to have a poor prognosis despite the use of antifungal therapy in leukemic patients. We studied the outcome of surgical resection of invasive pulmonary aspergillosis where bleeding tendency, localized recurrence of infection, and incidence could be reduced. Material and Method: We retrospectively reviewed 14 patients with a hematological malignancy where invasive pulmonary aspergillosis was diagnosed during the 10 years between 1998 and 2007. From the medical records, we reviewed the type and treatment of the hematological malignancy, including the diagnostic methods of invasive pulmonary aspergillosis, the preoperative hematological conditions and their management, and the surgical methods and records. We also analyzed the development of postoperative complications and patient mortality, the recurrence of postoperative invasive pulmonary aspergillosis, and if the patients had a bone marrow transplant. Result: Fourteen patients with invasive pulmonary aspergillosis and a hematological malignancy underwent a pulmonary lobectomy. One patient had a complication of bronchopleural fistula, but there were no other serious complications such as bleeding or wound infection, and none of the patients died postoperatively. Conclusion: We have shown that pulmonary lobectomy is a safe and effective therapy for invasive pulmonary aspergillosis in patients with hematological malignancies that allow further treatment of the hematological malignancy.

배경: 침습성 폐아스페르길루스증은 면역체계가 낮은 환자들에게 흔한 진균감염으로, 특히 백혈병으로 항암제 치료를 받고 있는 환자들에서는 항진균제 치료에 반응이 적은 것으로 알려져 있다. 저자들은 백혈병의 치료 중 합병된 폐아스페르길루스증에 대하여 모두 폐절제술을 시행하였으며, 그의 효과 등을 알아보고자 하였다. 대상 및 방법: 1998년 2월부터 2007년 4월까지 혈액암 질환의 진단과 함께 침습성 폐아스페르길루스증 진단을 받은 환자 14명을 대상으로 후향적인 검토를 하였다. 환자의 의무기록을 통해 혈액암(기저질환)의 종류와 그에 따른 치료, 침습성 폐아스페르길루스증의 진단방법, 수술 전 혈액학적 상태와 처치, 수술방법, 수술 후 합병증과 사망여부, 수술 후 폐아스페르길루스증의 재발현율 및 골수이식 여부 등을 조사하였다. 결과: 침습성 폐아스페르길루스증이 합병된 혈액암 환자 14명에서 모두 폐엽절제술이 시행되었다. 수술 후 1명의 환자에서 기관지흉막루가 발생되었으나, 기타 창상감염, 출혈 등의 위중한 합병증이나 수술 후 사망한 환자는 없었으며, 모두 백혈병치료를 지속할 수 있었다. 결론: 침습성 폐아스페르길루스증은 혈액암에 대한 치료 도중 종종 발생되는 위중한 질환이나, 폐엽절제술은 안전하며 효과적으로 혈액암의 치료를 유지시켜 줄 수 있는 치료법으로 생각한다.

Keywords

References

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