中文摘要：

目的 探讨伴有侵袭性肺曲霉病（IPA）的恶性血液病并行异基因造血干细胞移植（allo-HSCT）的患者手术切除肺部曲霉感染病灶后IPA的复发情况.方法 回顾性分析南方医科大学南方医院2007年1月-2014年7月16例诊断为IPA且移植前存在大于2.0 cm肺部空洞或包块的患者,其中10例患者移植前接受肺部病灶切除手术（手术组）,6例由于原发病未缓解或双肺存在多个病灶未接受手术（未手术组）.所有患者根据初始治疗的反应选择抗真菌二级预防（SAP）用药.比较两组allo-HSCT后IPA的复发率、突破率、SAP用药的中位时间和生存情况.结果 移植后中位随访时间为364（73～400）d.SAP的成功率为15/16,手术组与未手术组IPA的1年累积复发率分别为0和3/6（P =0.012）,两组的突破性侵袭性真菌病发生率分别为0和1/6（P=0.221）.手术组与未手术组患者SAP的中位时间分别为95（74 ～134）d和192.5（56 ～280）d,前者的SAP用药时间明显短于后者（P=0.017）.手术组与未手术组1年累积生存率分别为8/10和4/6（P=0.534）.无患者因药物不良反应终止SAP.结论 手术切除联合SAP有可能降低allo-HSCT后IPA复发率,同时可缩短SAP用药时间.

英文摘要：

Objective To explore the rate of breakthrough invasive pulmonary aspergillosis （IPA） in patients receiving surgical resection of pulmonary aspergillosis lesions prior to allogeneic hematopoietic stem cell transplantation （allo-HSCT）.Methods A retrospective analysis was conducted between January 2007 and June 2014.A total of 16 patients were enrolled, who had persistent pulmonary lesions including cavity （diameter 〉 2.0 cm） or mass with a history of IPA prior to allo-HSCT in Nanfang Hospital of Southern Medical University.Ten of the 16 patients underwent thoracoscopic surgery before transplantation, i.e.surgery group, the other 6 patients did not have surgery because of primary underlying diseases （noncomplete remission） or multiple lesions i.e.non-surgery group.Secondary prophylactic agents were administrated based on treatment response to initial antigual therapy.The l-year cumulative and breakthrough rate of IPA, the median time of secondary antifungal prophylaxis （SAP） and overall survival were compared between surgery and non-surgery groups.Results Within a median follow-up of 364 days after transplantation （range 73 to 400 days）.The success rate of SAP was 15/16.The 1-year cumulative and breakthrough IPA were 0 and 0 in surgery group, compared with 3/6 and 1/6 in non-surgery group.The median duration of SAP in surgery group and non-surgery group was 95 （74-134）days and 192.5 （56-280） days respectively, which was significantly shorter in surgery group （P =0.017）.The overall survival between two groups was 8/10 and 4/6 （P =0.534）.No discontinuation of SAP happened in both groups due to drug-related adverse events.Conclusions In patients with persistent pulmonary IPA lesions, surgical resection followed by SAP might be effective to reduce breakthrough IPA after transplantation with short duration of prophylaxis.