Watanabe Masazumi, Hasegawa Naoki, Ishizaka Akitoshi, Asakura Keisuke, Izumi Yotarao, Eguchi Keisuke, Kawamura Masafumi, Horinouchi Hirohisa, Kobayashi Koichi
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Ann Thorac Surg. 2006 Jun;81(6):2026-30. doi: 10.1016/j.athoracsur.2006.01.031.
The purpose of this study was to examine the postoperative outcomes of patients with Mycobacterium avium complex (MAC) lung lesions persisting despite treatment with multiple antibiotics.
Patients with localized pulmonary lesions persisting despite extensive state-of-the art antimicrobial chemotherapy became candidates for surgical resection. Twenty-two patients who were expected to retain sufficient postoperative pulmonary function were included in this study. These patients received chemotherapy for 2 to 37 months (mean, 17). Surgical procedures were lobectomy (n = 15), segmentectomy (n = 4), and partial lung resection (n = 6). Three patients underwent bilateral resections.
Mycobacterium avium complex causing bronchiectasis or cavitary lesions was detected preoperatively in all 22 patients. There was no major operative morbidity or mortality. Postoperative chemotherapy was continued for 6 to 35 months. All patients were alive and well at follow-ups ranging from 6 to 164 months (median, 46). Both vital capacity and forced expiratory volume in 1 second after surgery were maintained at 89% and 84% of the preoperative values, respectively. Mycobacterium avium complex disappeared from sputum after surgery in all patients. In 1 patient, 4 months after resection of a cavitary lesion, MAC-positive sputum presumed to be from the contralateral lung lesion became negative during continuation of chemotherapy.
The long-term outcomes of patients operated on for MAC resistant to antimicrobial chemotherapy were excellent. For such patients, we recommend surgery before the disease becomes exceedingly advanced and nonresectable. Additionally, in extensive disease, the excision of large cavitary bacterial foci may assist the medical management of contralateral lesions.
本研究的目的是检查尽管接受了多种抗生素治疗但鸟分枝杆菌复合群（MAC）肺部病变仍持续存在的患者的术后结局。
尽管接受了广泛的先进抗菌化疗，但局部肺部病变仍持续存在的患者成为手术切除的候选者。本研究纳入了22名预计术后仍能保留足够肺功能的患者。这些患者接受了2至37个月（平均17个月）的化疗。手术方式为肺叶切除术（n = 15）、肺段切除术（n = 4）和部分肺切除术（n = 6）。3名患者接受了双侧切除术。
所有22例患者术前均检测到导致支气管扩张或空洞性病变的鸟分枝杆菌复合群。无重大手术并发症或死亡。术后化疗持续6至35个月。所有患者在6至164个月（中位数46个月）的随访中均存活且状况良好。术后1秒用力呼气容积和肺活量分别维持在术前值的89%和84%。所有患者术后痰中鸟分枝杆菌复合群均消失。1例患者在空洞性病变切除术后4个月，在继续化疗期间，推测来自对侧肺部病变的MAC阳性痰转阴。
对抗菌化疗耐药的MAC患者手术治疗的长期结局良好。对于此类患者，我们建议在疾病变得极其严重且无法切除之前进行手术。此外，在广泛病变的情况下，切除大的空洞性细菌病灶可能有助于对侧病变的药物治疗。
