Tuberculosis and Respiratory Diseases
- 제52권1호
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- Pages.46-53
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- 2002
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- 1738-3536(pISSN)
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- 2005-6184(eISSN)
국균종의 임상적 고찰
Clinical Characteristics of Aspergilloma
- 김기업 (순천향대학교 의과대학 내과학교실) ;
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길효욱
(순천향대학교 의과대학 내과학교실) ;
- 이석호 (순천향대학교 의과대학 내과학교실) ;
- 김도진 (순천향대학교 의과대학 내과학교실) ;
- 나문준 (건양대학교 의과대학 내과학교실) ;
- 어수택 (순천향대학교 의과대학 내과학교실) ;
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김용훈
(순천향대학교 의과대학 내과학교실) ;
-
박춘식
(순천향대학교 의과대학 내과학교실)
- Kim, Ki-Up (Department of Internal Medicine, Soonchunhyang University Hospital) ;
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Gil, Hyo-Wook
(Department of Internal Medicine, Soonchunhyang University Hospital) ;
- Lee, Suk-Ho (Department of Internal Medicine, Soonchunhyang University Hospital) ;
- Kim, Do-Jin (Department of Internal Medicine, Soonchunhyang University Hospital) ;
- Na, Moon-Jun (Department of Internal Medicine, Kunyang University) ;
- Uh, Soo-Taek (Department of Internal Medicine, Soonchunhyang University Hospital) ;
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Kim, Yong-Hoon
(Department of Internal Medicine, Soonchunhyang University Hospital) ;
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Park, Choon-Sik
(Department of Internal Medicine, Soonchunhyang University Hospital)
- 발행 : 2002.01.30
초록
연구배경 : 폐 국균종은 우리나라에서 비교적 흔히 볼 수 있는 만성적인 진균감염으로서 방사선학적으로는 air-crescent를 특징으로 하는 질환이다. 객혈이 주요 증상이고, 주된 선행질환으로 폐결핵이 알려져 있다. 진단은 방사선학적으로 공동내 고형 및 원형의 종괴가 공동의 벽과 분리되어 존재하는 것이며 혈청학적 검사가 진단에 도움이 된다. 치료에서는 항진균제를 포함한 보존적 치료와 수술이 있는데, 최근에는 환자의 전신상태가 양호한 경우 수술이 선호되는 경향을 보인다. 저자들은 국균종이 의심되는 환자 중 수술로서 확진이 되거나 국균항체 양성으로 판정된 환자의 임상 양상에 대하여 알아보고자 하였다. 대상 및 방법 : 1995년 1월부터 2000년 12월까지 문진과 진찰소견, 단순 흉부 방사선 검사와 전산화단층촬영에서 국균종이 의심되는 58례 중 수술을 하여 확진된 경우 9례, 기관지 내시경 및 경피적 침 생검과 국균종에 대한 항제 양성을 보이는 13례를 대상으로 후향적 분석을 하였다. 결 과 : 1) 기저질환으로는 폐결핵이 16례 (72.7%)였으며, 이중 현재 결핵균 동정에서 비결핵항산균이 3례가 있었다. 완치판정을 받은 결핵환자에서 국균종을 진단할 때까지 기간은
Background: Pulmonary aspergilloma is relatively common in korea. It arises from the colonization and proliferation of Aspergillus in preexisting lung parenchymal cavities, in particular tuberculosis. The most common symptom in this disorder is hemoptysis, which mayor may not be massive and life threatening. A routine chest radiography and computed tomography (CT) are the most important diagnostic procedures. A surgical resection of the aspergilloma has recently been recommended, because of the relatively low incidence of postoperative complications than in the past. A more concentrated sample of patients with aspergilloma, who either underwent a thoracotomy or tested positive for aspergillus antibodies, were reviewed. Method : The medical records of twenty-two patients with aspergilloma, who had a proven thoracotomy (9 cases), or who tested positive for the diagnostic procedure and/or aspergillus antibodies (13 cases) from January 1995 to December 2000, were reviewed retrospectively. Results : The most common underlying lung disease was a current or old healed tuberculosis, and 3 patients had cultures of mycobacterium other than tuberculosis (MOTT). The mean time until the aspergilloma was detected 5.91 years in the healed tuberculosis cases. The others cases involved a lung abscess, bronchiectasis and without lung disease. The extrapulmonary disease was alcoholism and diabetes. Hemoptysis was most common in 72.7%. A computed tomography (CT) is useful for diagnosis. The right upper lobe, especially the posterior segment, is the most common location. Bronchial artery embolization is ineffective for a long term follow-up. A lobectomy is most common in a thoracotomy, and intra-operative and post-operative complications are rare. During follow-up, the mortality rate, not from the aspergilloma but from respiratory failure, was 13.6%. Conclusion : Aspergilloma is a common cavitary lung disease, It mainly arises from tuberculosis, either current or healed, but extra-pulmonary disease including alcoholism or diabetes are other possible risk factors. Their most common problem in aspergilloma is hemoptysis. Surgery has a low risk of post-operative complications and is recommended in relatively preserved lung function or healthy patients. Medical maneuvers including embolization, and the local insertion of certain materials needs to be studied more closely.