CAJ | 학술논문

目的通过外科手术或胸腔镜技术去除恶性血液病肺部并发症患者的肺部病灶,并明确病灶性质.方法对17例血液系统恶性肿瘤有肺部并发症,诊断不明和内科治疗无效患者进行开胸手术或胸腔镜肺叶全切、部分切除或病变部位楔形切除术,并对所取组织标本行常规苏木精-伊红染色病理形态学观察.结果术后组织病理结果证实:9例患者为肺部曲霉菌感染;3例为亚急性炎症,纤维化伴血肿;1例为肺梗死,周边局部肉芽肿改变;1例为肉芽肿性炎症伴钙化结节;1例为肺泡腔扩张伴出血,间质纤维化,灶性血管炎;1例为肋间神经鞘瘤;1例为中分化腺癌伴肺内转移.术前术后诊断符合率达64.3%(14例中9例).手术并发症包括真菌种植1例、胸腔积液伴胸膜黏连3例,肺内血肿2例.术后8例患者接受异基因或自体造血干细胞移植(HSCT)7例移植顺利.证实为曲菌病感染的5例患者,接受真菌再发预防治疗的同时实施移植,4例移植顺利,始终未出现真菌复发,1例肺部真菌感染再发死亡.结论恶性血液病患者合并迁延不愈或内科保守治疗无效或咯血的肺部感染,或诊断不明的肺部病变,应及时接受手术治疗清除病灶,明确诊断,为血液病后续治疗创造条件.
목적 통과외과수술혹흉강경기술거제악성혈액병폐부병발증환자적폐부병조,병명학병조성질.방법 대17례혈액계통악성종류유폐부병발증,진단불명화내과치료무효환자진행개흉수술혹흉강경폐협전절、부분절제혹병변부위설형절제술,병대소취조직표본행상규소목정-이홍염색병리형태학관찰.결과 술후조직병리결과증실:9례환자위폐부곡매균감염;3례위아급성염증,섬유화반혈종;1례위폐경사,주변국부육아종개변;1례위육아종성염증반개화결절;1례위폐포강확장반출혈,간질섬유화,조성혈관염;1례위륵간신경초류;1례위중분화선암반폐내전이.술전술후진단부합솔체64.3%(14례중9례).수술병발증포괄진균충식1례、흉강적액반흉막점련3례,폐내혈종2례.술후8례환자접수이기인혹자체조혈간세포이식(HSCT)7례이식순리.증실위곡균병감염적5례환자,접수진균재발예방치료적동시실시이식,4례이식순리,시종미출현진균복발,1례폐부진균감염재발사망.결론 악성혈액병환자합병천연불유혹내과보수치료무효혹각혈적폐부감염,혹진단불명적폐부병변,응급시접수수술치료청제병조,명학진단,위혈액병후속치료창조조건.
Objective To determine the pulmonary pathological changes in hematological malignancy patients with pulmonary complications.Methods 17 hematological malignancy patients underwent surgical treatment were evaluated retrospectively.The pathological changes of all the surgical specimens were examined postoperatively by standard hematoxylin and eosin(HE) staining.Results Pathological examination confirmed:aspergillus infection in 9 patients,sub-acute inflammation (fibrosis and hematoma formation) in 3,and each in 1 of pulmonary infarction with granulomatous tissue in the periphery;granulomatous inflammation with calcified tubercle;alveolar dilation and hemorrhage,interstitial fibrosis and focal vasculitis;intercostal neurilemmoma;and moderate-differentiated adenocarcinoma accompanied by intrapulmonary metastasis.And several operative complications (1 case of fungal implantation,3 pleural effusion and adhesions and 2 pulmonary hematoma) were occurred.The coincidence rate of pre- and post-operative diagnosis was 9/14 (64.3%).After surgery,8 patients were received hematopoietic stem cell transplantation (HSCT,allo-gene or autologous),with 7 succeeded.On effective secondary antifungal prophylaxis,4 of 5 patients of aspergillosis succeeded in transplantation with free from mycotic relapse,one patient died from fungal relapse.Conclusion Hematological malignancies with persistent and/or resistant pulmonary infection,hemoptysis,or unexplained lung diseases, should be treated in time by surgery operation to effectively eliminate residual disease and obtain a definitive diagnosis, so as to create a prerequisite condition for the following treatments.Moreover, the secondary antifungal prophylaxis can provide active roles for patients scheduled for chemotherapy and/or HSCT.