Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA 30333, USA.
Int J Tuberc Lung Dis. 2013 Jan;17(1):6-16. doi: 10.5588/ijtld.12.0198.
With the emergence of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), surgery, which had been replaced by short-course chemotherapy, is again being considered a viable treatment option.
To assess the literature on the effectiveness of surgical interventions in the treatment of drug-resistant TB.
Medline, EMBASE, and PubMed were searched from 1975 to April 2012 in addition to hand searching reference lists, and the International Journal of Tuberculosis and Lung Disease. Potentially relevant studies were assessed according to pre-defined eligibility criteria: MDR- and XDR-TB patients undergoing surgical and non-surgical treatment. Treatment outcomes were extracted according to internationally accepted definitions and included in meta-analyses using random effects models.
Summary meta-analysis of 24 comparison studies revealed a significant association between surgery and successful treatment compared to non-surgical interventions (OR 2.24, 95%CI 1.68-2.97). A meta-analysis from 23 single-arm studies demonstrated that respectively 92% (95%CI 88.1-95) and 87% (95%CI 83-91) of surgical patients achieved successful short- and long-term outcomes. Subgroup analyses showed that favorable surgical outcomes were associated with increased drug resistance in studies reporting surgical and non-surgical treatment outcomes.
While the results suggest that surgical intervention is associated with successful treatment outcomes in patients with drug-resistant TB, there is insufficient evidence to recommend surgery plus chemotherapy over chemotherapy alone, to evaluate the potential harm from surgery and to determine the optimal conditions for surgery. Controlled studies are needed to better assess the effectiveness of surgery and to investigate other contextual issues.
随着耐多药（MDR-）和广泛耐药（XDR-TB）结核病的出现，手术已被短期化疗所取代，但再次被认为是一种可行的治疗选择。
评估外科干预治疗耐药结核病的文献。
从 1975 年到 2012 年 4 月，我们在 Medline、EMBASE 和 PubMed 上进行了检索，此外还检索了参考文献列表和《国际结核病和肺部疾病杂志》。根据预先确定的合格标准评估潜在相关研究：接受手术和非手术治疗的耐多药和广泛耐药结核病患者。根据国际公认的定义提取治疗结果，并使用随机效应模型进行荟萃分析。
对 24 项比较研究的汇总荟萃分析显示，手术与非手术干预相比，与成功治疗有显著相关性（OR 2.24，95%CI 1.68-2.97）。来自 23 项单臂研究的荟萃分析表明，分别有 92%（95%CI 88.1-95）和 87%（95%CI 83-91）的手术患者获得了短期和长期的成功结果。亚组分析表明，在报告手术和非手术治疗结果的研究中，手术结果良好与药物耐药性增加相关。
尽管结果表明手术干预与耐药结核病患者的成功治疗结果相关，但尚无足够证据推荐手术加化疗优于单纯化疗，以评估手术的潜在危害并确定手术的最佳条件。需要进行对照研究，以更好地评估手术的有效性，并研究其他背景问题。
