[Surgical treatment for pulmonary aspergillosis]

Between 1985 and 1994, 141 patients with pulmonary aspergilloma underwent surgical treatment in 18 hospitals, which belong to Japanese Tuberculosis Research Committee. Applied surgical procedures are divided into two major categories. One is pulmonary resection variety, and the other is lung preserving or space reducing surgery. The former consists of 20 pneumonectomies, 62 lobectomies and 13 lesser operations. The latter is composed of combined mordalities of space reducing surgery (SRS) such as thoracoplasty, air-plombage, cavernoplasty and muscle plombage to reduce the cavity or the emphysematous bulla, which contains fungus balls within it. This kind of operation is applied for the patients, who have impaired lung function, strong pleural adhesion and severe complications. Triad of thoracoplasty, cavernoplasty and muscle plombage is the most frequent combination and was applied to 20 patients in this study. Operative mortality is one in pulmonary resection group and none in SRS group. Hospital deaths are two in the former and one in the latter. Success rate of operation is 95.8% in pulmonary resection, and 78.3% in SRS, especially 85.0% in the triad, mentioned above. However, SRS required a couple of additional operation on occasion to reach final success. Morbidity rate is 23.2% in pulmonary resection, and 17.4% in SRS. Thoracic empyema with or without bronchial fistula is the most common complication of the former. On the other hand, infection of the residual cavity and subcutaneus abcess are the main complications of the latter.