Analysis Of Treatment Of Chronic Cavernous Pulmonary Aspergillosis Based On Prospensity Score Matching

Objective:To explore the clinical efficacy of surgical treatment and antifungal therapy in patients with chronic cavitary pulmonary aspergillosis(CCPA),and to determine the safety and efficacy of video-assisted thoracoscopic surgery in the treatment of CCPA.Methods:All the inpatients with CCPA diagnosed in the affiliated Hospital of Qingdao University from February 2012 to February 2012 were collected according to the following conditions: 1,the lung function was good and could tolerate the operation;2,there was no immune system disease or immune function deficiency;3,the focus was limited to one side of the lung lobe;4,other surgical taboos were excluded;5,all patients were not treated with antifungal therapy before hospitalization.A total of 94 eligible inpatients were selected and divided into observation group and control group according to the mode of treatment.Through propensity score matching(PSM),using treatment as a dependent variable,8 items including age,gender,presence or absence of underlying lung disease,lesion size,number of holes,BMI,diabetes,hypertension,etc.were used as covariates,caliper(matching tolerance)was set to 0.1,and matching was performed at 1:1.A total of 23 pairs of patients were successfully matched.All the patients in the observation group were treated with video-assisted thoracic surgery(VATS),and all the patients in the control group were treated with antifungal drugs.To retrospectively analyze and compare the clinical efficacy and prognosis of the two groups of patients.Statistical methods: the quantitative data of normal distribution were expressed by statistical (?)±s,and the t-test or t 'test was used to compare the variance between groups.The classified data were expressed by frequency and percentage,and the disordered classified data were compared by Chi-squared test or Fisher exact probability test.The cure rate was estimated by Kaplan-Meier method,and the cure curve was compared by Log-rank test.The difference was statistically significant(P<0.05).According to intention to treat analysis(ITT):the death and loss of follow-up in the observation group were counted as ineffective treatment,while those in the control group were counted as cured.Results: After matching,23 patients in the observation group were successfully treated by operation.The operative methods were VATS segmental lobectomy(n=3)and VATS lobectomy(n=18),VATS combined lobectomy(n=2).3 cases were converted to open operation because of extensive pleural adhesion or pleural atresia,and 1 case was converted to open operation because of intraoperative bleeding.Postoperative complications occurred in 3 cases(13.04%).The treatment results were followed up: 21 cases were cured,1 case lost follow-up,and 1 case died of "traffic accident" during 3 months follow-up.23 patients in the control group were treated with antifungal therapy.The method of administration: voriconazole injection,usage and dosage: 6mg/kg,Q12 h on the first day;4mg/kg,Q12h/day from the next day and oral voriconazole after 2 weeks.Usage and dosage: 4mg/kg,Q12 h.Adverse reactions: 2 patients had transient visual impairment and did not stop taking drugs,and the symptoms disappeared after 1 day.Five patients had abnormal liver function and were given symptomatic and supportive treatment such as liver protection.Among them,3 patients improved after treatment,and the other 2 patients showed no significant improvement in liver protection treatment."voriconazole" was replaced by "caspofungin" to continue treatment,usage and dosage: a single 70 mg load dose on the first day,followed by a single dose of 50 mg a day,liver function was improved after re-examination.After the total treatment time reached 2 weeks,oral "itraconazole" was used sequentially.The usage and dosage were 2.5mg/kg,Q12 h.The follow-up results showed that 5 cases were cured,6 cases were markedly effective,4 cases were effective,6 cases recurred,1 case died and 1 case lost follow-up.There was significant difference in the total hospitalization days between the two groups after matching(P=0.026 < 0.05).There was no significant difference in the total effective rate between the two groups(P=0.137>0.05),but the difference in cure rate was statistically significant(P=0<0.05).Conclusion:For those patients with CCPA whose lesions are limited to one lung lobe or one lung tissue,VATS is an effective method,which can not only clarify histopathology,but also radical resection of the lesions,with fewer postoperative complications and can be cured in a short time,and the cure rate is higher than that of antifungal therapy.