The Comparison Between Two Therapeutic Methods Of Secondary Pulmonary Aspergilloma After Pulmonary Tuberculosis

【Objective】The aim of the study is to correctly enact treatment protocols in secondary pulmonary aspergilloma of prior cavitary tuberculosis. In order to achieve this objective ,we do the study in 183 cases who received either fiberoptic bronchoscopy intervention or surgery and compare the clinical value of two methods.【Methods】We conducted a retrospective study on the patients with pulmonary aspergilloma were diagnosed from 2003 to 2009 in Guangzhou Chest Hospital.We collected the demography of the patients ,evidences of diagnosis, including clinical characters, CT, Pathology examination, therapeutic regimens,length of the stay, cost of hospitalization, complication and treatment effectiveness.【Results】(1) A total of 183 patients were reviewed. 138 patients were male and 45 were female. Their ages range from 14 to 76 with a mean of 45.6.(2)126 patients have received interventional therapy by fiberoptic bronchoscopy.98 patients were male and 28 were female. Their ages range from 16 to 76 with a mean of 48.3. 57 patients have received surgery.40 patients were male and 17 were female. Their ages range from 14 to 71 with a mean of 38.2.(3) Average hospitalized time of 126 cases who recepted interventional therapy by bronchoscopes is 49 days,however, of 57 cases who recepted surgery is 46 days. Average treatment costs who recepted bronchoscopes is 26535 yuan,however, who recepted surgery is 50296 yuan.(4)In 57patients accepting surgery ,there were 21 cases transoperative bleeding overtopping 500ml,8 cases with bronchus stump or pleura fistula,2cases with excessive postoperative blood oozing from the wound surface. 1 patient died because of excessive hemorrhage .In 126 patients accepting interventional therapy by bronchoscopes, there were 11cases bleeding overtopping 100 ml.(5) In 126 patients accepting interventional therapy by bronchoscopes,the pulmonary intracavitary aspergilloma of 91 cases had been completely cleaning. Pulmonary aspergilloma had been completely cleaning in 57 patients accepting surgery.(6)follow-up of afteroperation:we trace 91 cases of pulmonary intracavitary aspergilloma been completely cleaning by bronchoscopes for 36 months.3cases recured. 57 patients accepting surgery.except 1case dying of excessive hemorrhage have not recured.【Conclusions】The patients who suffer secondary pulmonany aspergilloma can obtain relatively thorough and effective treatment by﹙bronchoscope .The interventional therapy by bronchoscope bring less and light complications.The treatment costs of bronchoscope is less than that of surgery.Interventional therapy by bronchoscope maybe is a better selection because of surgery bringing huge risk,minor reserve of lung function,or the patient not receiving gross injuries of surgery.