Mohsen Tarek, Zeid Amany Abou, Haj-Yahia Saleem
Department of Cardiothoracic Surgery, Kasr El Aini Hospital, Cairo University, Cairo, Egypt.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):194-8. doi: 10.1016/j.jtcvs.2007.03.022.
Combination chemotherapy is considered the first-line treatment for pulmonary tuberculosis. Despite related morbidity, the need for surgical resections coincides with the emergence of multidrug-resistant tuberculosis. This study presents a single-institution retrospective audit of the surgical management of 23 patients with multidrug-resistant tuberculosis.
We analyzed 23 consecutive patients undergoing anatomic pulmonary resections for human immunodeficiency virus-negative multidrug-resistant tuberculosis. Twenty were male (87%) and 3 were female (13%); their mean age was 24.4 years. We defined resistance in this cohort as failure to respond to combination chemotherapy, including isoniazid and rifampicin, with a mean duration of administration being 90 days. Fifteen of 23 (65.3%) patients, although sputum negative, were considered at risk for relapse owing to extensive parenchymal disease. Eight (34.7%) of 23 patients were sputum positive at the time of operation. We performed pneumonectomy on 11 (47.8%) and lobectomy on 12 (52%) patients. All had adjuvant chemotherapy for 18 to 24 months, with follow-ups ranging from 14 to 27 months.
Stay in the intensive treatment unit was 2.9 days (range 1-17 days) and hospital stay, 8.6 days (range 5-45 days). Four (17%) patients had prolonged air leak, 3 (13%) required further treatment for empyema, with re-exploration for bleeding in 1 (4%). Hospital mortality was 4.3%. All patients attained sputum-negative status postoperatively (range 1-5 months). One (4%) patient had a relapse after 12 months.
Surgery should be considered as an adjunct to medical therapy when eradicating multidrug-resistant tuberculosis in affected patients. Anatomic lung resections can be performed with acceptable morbidity and mortality. Early referral of such patients for surgical consideration is warranted.
联合化疗被视为肺结核的一线治疗方法。尽管存在相关发病率，但随着耐多药结核病的出现，手术切除的需求也随之而来。本研究对23例耐多药结核病患者的手术治疗进行了单机构回顾性审计。
我们分析了23例因人类免疫缺陷病毒阴性耐多药结核病接受解剖性肺切除的连续患者。其中20例为男性（87%），3例为女性（13%）；他们的平均年龄为24.4岁。我们将该队列中的耐药定义为对包括异烟肼和利福平在内的联合化疗无反应，平均给药时间为90天。23例患者中有15例（65.3%），尽管痰菌阴性，但由于广泛的实质性病变被认为有复发风险。23例患者中有8例（34.7%）在手术时痰菌阳性。我们对11例（47.8%）患者进行了全肺切除术，对12例（52%）患者进行了肺叶切除术。所有患者均接受了18至24个月的辅助化疗，随访时间为14至27个月。
在重症监护病房的停留时间为2.9天（范围为1 - 17天），住院时间为8.6天（范围为5 - 45天）。4例（17%）患者出现持续漏气，3例（13%）因脓胸需要进一步治疗，1例（4%）因出血需要再次探查。医院死亡率为4.3%。所有患者术后均达到痰菌阴性状态（范围为1 - 5个月）。1例（4%）患者在12个月后复发。
在根除受影响患者的耐多药结核病时，手术应被视为药物治疗的辅助手段。解剖性肺切除可以在可接受的发病率和死亡率下进行。此类患者应尽早转诊以考虑手术治疗。
