Muzaffer METİN, Adnan SAYAR, Atilla PEKÇOLAKLAR, Alper ÇELİKTEN, Abdülaziz KÖK, Necati ÇİTAK, Neslihan FENER AKANIL, Atilla GÜRSES

Pulmoner aspergillomada altı yıllık 26 olguluk cerrahi tedavi sonuçları: Tek cerrahi servisinin deneyimi

Pulmoner aspergillomanın cerrahi tedavisi risk açısından nam salmıştır. Cerrahi olarak tedavi ettiğimiz pulmoner aspergillomalı olgularımızın sonuçlarını inceledik. 2003-2009 yılları arasında kliniğimizde cerrahi olarak tedavi uyguladığımız 26 pulmoner aspergillomalı olguyu ve operasyon sonuçlarını retrospektif olarak inceledik. Yirmi biri erkek, beşi kadın olan olguların yaş ortalamaları 44 ± 11.6 (dağılım: 28-70) yıl idi. Olgular grup A (basit aspergilloma; n= 8), grup B (kompleks aspergilloma; n= 18) olarak iki gruba ayrıldı. En sık altta yatan hastalık %61.5 ile tüberkülozdu. Operasyon için belirlenen en sık endikasyon altısı masif veya tekrarlayan ataklar şeklinde olan 15 (%57.6) olguyla hemoptiziydi. Diğer olgular hafif semptomları bulunan veya asemptomatik seyreden olgulardı. On beş (%57.6) olguya lobektomi, 8 (%30.6) olguya wedge rezeksiyon veya segmentektomi, 2 (%7.6) olguya pnömonektomi, 1 (%3.8) olguya kavernoplasti uygulanmıştı. Postoperatif olarak 15 olguda komplikasyon gelişti. Kompleks aspergillomalı olguların %72.2’sinde komplikasyon izlenirken, basit aspergillomalı olguların %25’inde görüldü (p= 0.03). En çok görülen komplikasyonlar uzamış hava kaçağı, ampiyem ve ekspansiyon kusuruydu. Kompleks aspergilloma için lobektomi uygulanan 1 (%3.8) olguda bronkoplevral fistül gelişti ve postoperatif 20. günde hasta kaybedildi. Ortalama hastanede yatış süresi 12.9 gündü. Olgular ortalama 44 ay takip edildi. Üç yıllık sağkalım basit aspergillomalı olgularda %100 iken, bu oran kompleks aspergillomalı olgularda %90 idi (p> 0.05). Takip sürecinde 2 (%8) olguda hastalığın tekrarladığı saptandı. Ancak hemoptizi semptomunda nüks izlenmedi. Lokalize pulmoner hastalığı bulunan olgularda morbidite daha az saptanmaktadır. Pulmoner fonksiyonları yeterli olan, asemptomatik ve semptomatik aspergillomalı olgularda parankim koruyucu cerrahi rezeksiyon; hayatı tehdit edebilecek hemoptizi ataklarını ve rekürrensi en aza indirdiğinden, kabul edilebilir morbidite-mortalite ve iyi sağkalım sonuçlarıyla uygulanabilir.

Results of surgical treatment for pulmonary aspergilloma with 26 cases in six years: a single center experience

Surgery for pulmonary aspergilloma is reputed to be risky. We analyzed our results of the surgical treatment for pulmonary aspergilloma. Between 2003 and 2009, 26 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our center. Results were evaluated retrospectively. There were 5 female and 21 male patients, with a mean age of 44 ± 11.6 years (28-70). The patients were divided into two groups, group A (simple aspergilloma; n= 8) and group B (complex aspergilloma; n= 18). Major underlying diseases were tuberculosis (61.5%). The most common indication for operation was hemoptysis (57.6%). Of our patients, 23% were complaining of massive hemoptysis or recurrent hemoptysis. Other patients were complaining of mild symptoms and some of them were totally asymptomatic. We performed 15 (57.6%) lobectomies (3 with associated segmentectomies), 8 (30.6%) segmentectomies/wedge resections, 2 (7.6%) pneumonectomies, and 1 (3.8%) cavernoplasty. Postoperative complications occurred in 15 (57.6%) patients. Complications occurred in 72.2% patients of complex aspergilloma, whereas 25% occurred in simple aspergilloma (p= 0.03). Major complications included prolonged air leak, empyema, air space. One patient who underwent lobectomies for complex aspergilloma developed bronchopleural fistula and died of respiratory failure on the 20th postoperative day. Operative mortality was 3.8%. The average postoperative hospital stay was 12.9 days. The mean follow-up period was average 44 months. The actuarial survival at 3 years was 90% and 100% for complex aspergilloma and simple aspergilloma, respectively (p> 0.05). There was two recurrence of disease (8%). But no recurrence of hemoptysis. Low morbidity rate may have been due to the selection of patients with localized pulmonary disease in this study. Surgical resection of asymptomatic or symptomatic pulmonary aspergilloma is effective in preventing recurrence or massive hemoptysis for patients whose condition is fit for pulmonary resection with reasonable mortality, morbidity and survival rates.

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