[Clinical analysis of comprehensive bronchoscopic interventional therapy for invasive pulmonary aspergillosis]

Objective: To investigate the bronchoscopic features of invasive pulmonary aspergillosis (IPA) and to summarize the clinical efficacy of comprehensive bronchoscopic interventional therapy. Methods: A retrospective analysis was conducted on the clinical data of 11 patients with IPA who received comprehensive bronchoscopic interventional therapy at Beijing Tsinghua Changgung Hospital between December 2018 and December 2024. The therapeutic efficacy and safety were evaluated. Results: Among the 11 patients, 7 were male and 4 were female, with an age range of 14 to 69 years (mean 45.8±17.6 years). Underlying diseases included diabetes mellitus (4 cases), hematological malignancies (2 cases), solid tumors (2 cases), anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (1 case), high IgE recurrent infection syndrome (1 case) and allergic bronchopulmonary aspergillosis (1 case). Chest CT findings showed multi-lobar involvement in nine cases and single-lobar involvement in two cases. Bronchoscopy revealed obstructive white necrotic material within the airways in four cases, purulent secretions in four cases, and bronchopulmonary cavity fistula in three cases. Pathological examination of the necrotic material confirmed the presence of abundant Aspergillus hyphae. All patients received systemic antifungal therapy. Local treatments included aerosolized amphotericin B deoxycholate inhalation in nine cases and bronchoscopic local drug perfusion in all 11 cases. Bronchoscopic interventional procedures included forceps removal of lesions in four cases, with one case experiencing grade Ⅲ hemorrhage. No severe complications such as pneumothorax occurred. Following treatment, clinical cure was achieved in six cases (54.5%) and significant improvement in five cases (45.5%), with no deaths. During the one-year follow-up, no recurrence was observed in 10 cases. Conclusions: IPA commonly occurs in immunocompromised hosts, with bronchoscopic findings often revealing airway obstruction caused by whitish necrotic material and/or secretions. An integrated therapeutic strategy combining systemic and local antifungal therapy with bronchoscopic interventional treatment can significantly enhance clinical efficacy and demonstrate a favorable safety profile.