Shiraishi Yuji
Section of Chest Surgery, Fukujuji Hospital, Kiyose, Tokyo.
Kyobu Geka. 2005 Jul;58(8 Suppl):724-8.
Since the introduction of rifampicin, it has been believed that pulmonary tuberculosis can be cured with medication alone. However, if tubercle bacilli are resistant to isoniazid and rifampicin, the success rate of medical treatment falls considerably. These bacilli are defined as multidrug-resistant tuberculosis (MDR-TB) and have been of great concern. To improve the outcome of chemotherapy in patients with MDR-TB, adjuvant resectional surgery has been advocated. Currently the most common indication for pulmonary resection in patients with tuberculosis is MDR-TB. Pulmonary resection for MDR-TB achieves a high cure rate with low morbidity and mortality. The majority of the MDR-TB patients in the previously reported surgical series were middle-aged, and pulmonary resection for MDR-TB has not been performed on the octogenarians. The oldest patient in our series was 65 years old. Nevertheless, pulmonary resection is worth considering for an octogenarian infected with MRD-TB because pulmonary resection achieves a high success rate with low morbidity and mortality.
自从利福平问世以来，人们一直认为肺结核仅靠药物治疗就能治愈。然而，如果结核杆菌对异烟肼和利福平耐药，药物治疗的成功率会大幅下降。这些杆菌被定义为耐多药结核病（MDR-TB），一直备受关注。为了提高耐多药结核病患者化疗的效果，有人主张进行辅助性切除手术。目前，结核病患者进行肺切除最常见的指征是耐多药结核病。耐多药结核病的肺切除治愈率高，发病率和死亡率低。先前报道的外科手术系列中的大多数耐多药结核病患者为中年人，尚未对八旬老人进行过耐多药结核病的肺切除手术。我们系列中的最年长患者为65岁。尽管如此，对于感染耐多药结核病的八旬老人，肺切除仍值得考虑，因为肺切除成功率高，发病率和死亡率低。
