目的:本研究旨在报告COVID相关性肺毛霉菌病的手术结局,特别强调手术死亡率。
方法:这项前瞻性观察性研究是在Gurugram的一个专门的胸外科病房进行的,印度超过18个月。人口学分析,进行围手术期变量。分析了各种参数以评估影响死亡率的因素。
结果:在研究期间对44例诊断为CAPM的患者进行了治疗。全部开始抗真菌治疗。然而,33例患者(75%)进行了手术,而其余11例(25%)被认为不适合手术。在手术队列中(n=33),有20名男性(60.6%)和13名女性(39.4%),平均年龄54.8岁(范围,33-72岁)。症状的平均持续时间为1.1周。5例(15.1%)进行非解剖楔形叶切除,26例(78.9%)需要肺叶切除/双叶切除,2例(6%)需要左肺切除.围手术期死亡5例(15.1%),都是因为真菌败血症.ECOG量表>2(P≤0.001),较高的Charlson合并症指数评分>2分(P=0.04)和肺切除术(P=0.02)是死亡率的预测因素.与NCPM相比,术后并发症发生率(P=0.50)和术后死亡率(P=0.69)无差异.
结论:CAPM应提供具有清晰切缘的积极手术切除,只要可行。与非COVID肺毛霉菌病相比,CAPM手术与更高的术后并发症,包括死亡率无关。
OBJECTIVE: This study aims at reporting the surgical outcomes of COVID associated pulmonary mucormycosis with special emphasis on surgical mortality.
METHODS: This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram, India over 18 months. An analysis of demography, peri-operative variables were carried out. Various parameters were analysed to assess the factors affecting mortality.
RESULTS: Total of 44 patients with diagnosis of CAPM were managed during the study period. All were started on anti-fungal therapy. However, 33 patients (75%) were operated whereas rest 11 (25%) were not considered suitable for surgery. In the surgical cohort (n = 33), there were 20 males (60.6%) and 13 females (39.4%), with a mean age of 54.8 years (range, 33-72 years). The mean duration of the symptoms was 1.1 weeks. Non-anatomical wedge resection of lobe(s) was performed in 5 patients (15.1%), lobectomy/bi-lobectomy was required in 26 patients (78.9%) and left pneumonectomy in 2 patients (6%). There were 5 peri-operative deaths (15.1%), all due to fungal sepsis. ECOG scale > 2 (P ≤ 0.001), higher Charlson Comorbidity Index score > 2 (P = 0.04) and pneumonectomy (P = 0.02) were the predictors of mortality. On comparison with NCPM, there was no difference in the incidence of post-operative complications (P = 0.50) and the post-operative mortality (P = 0.69).
CONCLUSIONS: Aggressive surgical resection with clear margins should be offered in CAPM, whenever feasible. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to Non-COVID Pulmonary Mucormycosis.