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Pulmoner Aspergillomada Cerrahi Tedavinin Yeri

The Role of Surgical Treatment in Pulmonary Aspergilloma

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Abstract (2. Language): 
Colonization of an existing intrapulmonary cavity with Aspergillus is called as Aspergilloma. Surgical treatment of Aspergilloma is recommended in asymptomatic patients since there is always a risk of sudden life-threatening hemoptysis. In contrary, surgical treatment of aspergilloma is disproved by same authors because of the high risk of morbidity and mortality. Four patients treated in our clinic are presented. All patients had hemoptysis, of whom three were serious. Three patients had history of tuberculosis and one had chronic liver disease. Chest radiogram and thoracic computed tomography revealed fungus ball in the cavity in all patients. Two patients were diagnosed with sputum smear and culture and one patient with fine needle aspiration biopsy preoperatively. We performed upper lobectomy in three patients the fourth patient was treated conservatively. Pathologic examination showed aspergillus fungus ball in all surgical patients. Morbidity included; incomplete re-expansion and upper residual pleural space in two patients and lower lobe atelectasis in one of them. Hemoptysis was not observed in any patient postoperatively. There was no serious morbidity, and no mortality in this small series of pulmonary aspergilloma treated with upper lobectomy, and control of hemoptysis was achieved in all. It can be cocluded that pulmonary resection is a safe and an effective treatment mortality in pulmonary aspergilloma, and pulmonary resection may be performed in patients who can tolerate it.
Abstract (Original Language): 
Akciğer parankimi içindeki bir kavitenin Aspergillus ile kolonize olmasına Aspergilloma denir. Asemptomatik olsa bile ani hayatı tehdit edici hemoptizinin oluşma riskinin sürekli mevcut olması nedeniyle Pulmoner Aspergillomada cerrahi önerilmektedir. Bunun aksine cerrahinin yüksek mortalitesi ve morbiditesi nedeniyle Aspergillomada cerrahi tedavinin uygun olmadığı da öne sürülmüştür. Kliniğimizde takip ve tedavi edilen 4 aspergilloma olgusu sunulmuştur. Hastaların üç tanesinde ciddi olmak üzere tümünde hemoptizi mevcuttu. Üç olguda eski tüberküloz öyküsü ve bir olguda ise kronik karaciğer hastalığı vardı. Akciğer grafisi ve bilgisayarlı toraks tomografilerinde kavite içinde mantar topu her olguda tesbit edildi. İki olgu balgam yayması ve kültürü ve bir olgu ince iğne aspirasyon biyopsisi ile preoperatif tanı aldı. Üç olguda üst lobektomi yapıldı, bir olguda semptomatik tedavi uygulandı. Ameliyat spesmenlerinin patolojik incelemesiyle her olguda Aspergillus mantar topu gösterildi. Morbidite; 2 olguda inkomplet reekspansiyon ve üstte rezidüel plevral boşluk ve bunlarda birinde alt lop atelektazisi şeklinde gelişti. Ameliyat sonrası hiçbir hastada hemoptizi olmadı. Üst lobektomi uygulanan bu küçük seride ciddi morbidite görülmedi ve mortalite yoktu ve hemoptizi kontrolü hepsinde sağlandı. Pulmoner aspergilloma tedavisinde pulmoner rezeksiyon emin ve etkin bir yöntemdir ve rezeksiyonu tolere edebilecek hastalarda uygulanabilir.
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Ölçme
n A, Akın H, Dinçer Sİ, Bekar Y, Metin M, Ölçmen M, Taşçı O. Aspergilloma: Cerrahi tedavi uygulanmış 26 olgu. GKDC Dergisi 1998;6:442-5.

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