Laisaar Tanel, Viiklepp Piret, Hollo Vahur
Indian J Tuberc. 2014 Jan;61(1):51-6.
Pulmonary tuberculosis continues to be a significant health problem, especially due to increasing incidence of multi-resistant mycobacteria and patients with immunodeficiency. Pulmonary tuberculoma, like other solitary lung nodules, can often be a diagnostic challenge; moreover no consensus exists on the management strategy.
To analyze the results of tuberculoma treatment with thoracoscopic lung resection, followed by anti-tuberculosis treatment (ATT).
All patients who underwent thoracoscopic resection of tuberculoma between 1996 and 2008 were retrospectively analyzed. The diagnosis was confirmed morphologically and/or microbiologically. Data were collected from case reports, outpatient medical records, Estonian Tuberculosis Registry and National Population Registry.
Forty-three patients (25 men, 18 women) with mean age of 43.3 (range 15-68) years were included. Thoracoscopic approach was converted to thoracotomy in three cases. Median postoperative stay in surgical department was four days. No intra-hospital mortality occurred. Eleven patients received pre-operative ATT for 8 to 288 (median 115) days and 42 patients were treated post-operatively for 40 to 672 (median 185) days. One patient defaulted in ATT. First-line drugs were prescribed in 37 and second-line in five patients. During the median follow-up of 9.0 (range 3.2 to 16.1) years, none of the patients developed relapse.
Thoracoscopic pulmonary resection provides a minimally invasive opportunity for morphological and microbiological diagnosis of tuberculoma; and results in an excellent cure rate in combination with ATT.
肺结核仍然是一个重大的健康问题，尤其是由于多重耐药分枝杆菌和免疫缺陷患者的发病率不断上升。肺结核瘤与其他孤立性肺结节一样，常常是一个诊断难题；此外，在管理策略上也没有达成共识。
分析胸腔镜肺切除术后抗结核治疗（ATT）对结核瘤的治疗效果。
回顾性分析1996年至2008年间所有接受胸腔镜切除结核瘤的患者。通过形态学和/或微生物学确诊。数据收集自病例报告、门诊病历、爱沙尼亚结核病登记处和国家人口登记处。
纳入43例患者（25例男性，18例女性），平均年龄43.3岁（范围15 - 68岁）。3例患者胸腔镜手术转为开胸手术。术后在外科的中位住院时间为4天。未发生院内死亡。11例患者术前接受ATT治疗8至288天（中位115天），42例患者术后接受治疗40至672天（中位185天）。1例患者未完成ATT治疗。37例患者使用一线药物，5例患者使用二线药物。在中位随访9.0年（范围3.2至16.1年）期间，无患者复发。
胸腔镜肺切除为结核瘤的形态学和微生物学诊断提供了微创机会；与ATT联合使用可获得极佳的治愈率。
