Shiraishi Yuji
Section of Chest Surgery, Fukujuji Hospital, 3-1-24 Matsuyama, Kiyose-shi, Tokyo, 204-8522, Japan,
Gen Thorac Cardiovasc Surg. 2014 Aug;62(8):475-80. doi: 10.1007/s11748-014-0402-1. Epub 2014 Apr 17.
While the prevalence of pulmonary tuberculosis has been decreasing, the prevalence of nontuberculous mycobacterial lung disease has been increasing. Unlike tuberculosis, nontuberculous mycobacterial disease is not communicable. However, their indolent nature may result in extensive parenchymal destruction, causing respiratory failure and vulnerability to airway infection. Nontuberculous mycobacterial lung disease, therefore, has been becoming a significant health problem. According to the 2007 American Thoracic Society/Infectious Diseases Society of America statement on nontuberculous mycobacterial diseases, the primary treatment is a multidrug treatment regimen. However, its efficacy is less than satisfactory for Mycobacterium avium complex lung disease, which is the most common type of nontuberculous mycobacterial lung diseases, and for Mycobacterium abscessus lung disease, which is notoriously resistant to chemotherapeutic drugs. The statement, therefore, has proposed a multidisciplinary treatment approach for these types of nontuberculous mycobacterial lung diseases: a combination of multidrug treatment regimen and adjuvant resectional surgery. This review covers the rationale, indication, procedure, and outcome of surgical treatment of nontuberculous mycobacterial lung disease. The rationale of surgery is to prevent disease progressing by removing the areas of lung most affected, harboring the largest amounts of mycobacteria. The indications for surgery include a poor response to drug therapy, the development of macrolide-resistant disease, or the presence of a significant disease-related complication such as hemoptysis. The surgical procedures of choice are various types of pulmonary resections, including wedge resection, segmentectomy, lobectomy, or pneumonectomy. The reported series have achieved favorable treatment outcomes in surgically treated patients with acceptable morbidity and mortality rates.
虽然肺结核的患病率一直在下降，但非结核分枝杆菌肺病的患病率却在上升。与结核病不同，非结核分枝杆菌病不具有传染性。然而，其隐匿性可能导致广泛的肺实质破坏，引起呼吸衰竭并易发生气道感染。因此，非结核分枝杆菌肺病已成为一个重大的健康问题。根据2007年美国胸科学会/美国传染病学会关于非结核分枝杆菌病的声明，主要治疗方法是多药治疗方案。然而，对于最常见的非结核分枝杆菌肺病类型——鸟分枝杆菌复合群肺病，以及对化疗药物具有 notoriously 耐药性的脓肿分枝杆菌肺病，该方案的疗效并不令人满意。因此，该声明针对这些类型的非结核分枝杆菌肺病提出了一种多学科治疗方法：多药治疗方案与辅助性切除手术相结合。本综述涵盖了非结核分枝杆菌肺病外科治疗的理论依据、适应症、手术方法及治疗结果。手术的理论依据是通过切除受影响最严重、含有大量分枝杆菌的肺组织来防止疾病进展。手术适应症包括对药物治疗反应不佳、出现大环内酯类耐药疾病，或存在咯血等与疾病相关的严重并发症。首选的手术方法是各种类型的肺切除术，包括楔形切除术、肺段切除术、肺叶切除术或全肺切除术。报道的系列研究在接受手术治疗的患者中取得了良好的治疗效果，发病率和死亡率均可接受。
