Abstract
Between 1978 and 1990, 34 patients (24 male and 10 female) underwent thoracotomy for the treatment of pulmonary aspergillosis. During this period, 622 patients were diagnosed as pulmonary aspergillosis in our hospital, so that the incidence of resection was 5.5%. In two of the 34 patients, lung cancer was suspected and in 24 patients hemoptysis or bloody sputum were the chief complaints. Fungus ball was observed in the preoperetive chest X-ray films in 31 Patients (86%). Twenty-four patients had a history of pulmonary tuberculosis and aspergillosis was thought to be its sequellae. In 12 patients, the durationl between the onset of pulmonary tuberculosis and pulmonary aspergillosis was less than 5 years, but in 5 patients it was over 15 years. Twenty-two patients underwent lobectomy, 8 pneumonectomy and 2 segmentectomy. Postoperative thoracoplasty was perfomed in 22 patients because of poor residual lung expansion.
The operation lasted more than 5 hours in 9 and the blood loss was more than 2000ml in 18 patients. In 3 patients the index (FEV1/predicted VC) was less than 40% preoperatively but there were 15 patients whose index became less than 40% postoperatively. The postoperative complications were observed in 20 patients, of which bronchopleural fistula in 7 patients was most serious.
Based on these experiences we believe that pulmonary resection is an effective procedure for the control of massive hemoptysis and persistent hemosputum, but the selection of the patients should be made carefully because of serious complications such as excessive bleeding during surgery, formations of bronchopleural fistula, empyema and postoperative respiratory failure. Development of effective antifungal drugs and new surgical procedure in place of resection is expected.
