Tseng Yau-Lin, Chang Jia-Ming, Liu Yi-Sheng, Cheng Lili, Chen Ying-Yuan, Wu Ming-Ho, Lu Chung-Lan, Yen Yi-Ting
From the Department of Surgery, Division of Thoracic Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan (Y-LT, Y-YC, Y-TY); Department of Surgery, Division of Thoracic Surgery, Chia-Yi Christian Hospital, Chia-Yi (J-MC); Graduate Institute of Medical Sciences, Collage of Health Science, Chang Jung Christian University, Tainan (J-MC); Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University (Y-SL, LC); Department of Surgery, Division of Thoracic Surgery, Tainan Municipal Hospital (M-HW); Center for Infection Control, National Cheng Kung University Hospital (C-LL); and Institute of Clinical Medicine, College of Medical College (J-MC, Y-TY), National Cheng Kung University, Tainan, Taiwan.
Medicine (Baltimore). 2016 May;95(18):e3511. doi: 10.1097/MD.0000000000003511.
There are few reports regarding video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis (TB). We reviewed our surgical results of video-assisted thoracoscopic surgery (VATS) therapeutic resection for pulmonary TB with medical failure, and its correlation with image characteristics on chest computed tomography (CT) scan.Between January 2007 and December 2012, among the 203 patients who had surgery for TB, the medical records of 89 patients undergoing therapeutic resection for medically failed pulmonary TB were reviewed. Clinical information and the image characteristics of CT scan were investigated and analyzed.Forty-six of the 89 patients undergoing successful VATS therapeutic resection had significantly lower grading in pleural thickening (P < 0.001), peribronchial lymph node calcification (P < 0.001), tuberculoma (P = 0.015), cavity (P = 0.006), and aspergilloma (P = 0.038); they had less operative blood loss (171.0 ± 218.7 vs 542.8 ± 622.8 mL; P < 0.001) and shorter hospital stay (5.2 ± 2.2 vs 15.6 ± 15.6 days; P < 0.001). They also had a lower percentage of anatomic resection (73.9% vs 93.0%; P = 0.016), a higher percentage of sublobar resection (56.5% vs 32.6%; P = 0.023), and a lower disease relapse rate (4.3% vs 23.3%; P = 0.009). Eighteen of the 38 patients with multi-drug resistant pulmonary tuberculosis (MDRTB) who successfully underwent VATS had significantly lower grading in pleural thickening (P = 0.001), peribronchial lymph node calcification (P = 0.019), and cavity (P = 0.017). They were preoperatively medicated for a shorter period of time (221.6 ± 90.8 vs 596.1 ± 432.5 days; P = 0.001), and had more sublobar resection (44.4% vs 10%), less blood loss (165.3 ± 148.3 vs 468.0 ± 439.9 mL; P = 0.009), and shorter hospital stay (5.4 ± 2.6 vs 11.8 ± 6.9 days; P = 0.001).Without multiple cavities, peribronchial lymph node calcification, and extensive pleural thickening, VATS therapeutic resection could be safely performed in selected patients with medically failed pulmonary TB as an effective adjunct with satisfactory results.
关于电视辅助胸腔镜治疗药物治疗失败的肺结核（TB）的报道较少。我们回顾了我们对药物治疗失败的肺结核患者进行电视辅助胸腔镜手术（VATS）治疗性切除的手术结果，以及其与胸部计算机断层扫描（CT）图像特征的相关性。2007年1月至2012年12月期间，在203例接受TB手术的患者中，回顾了89例因药物治疗失败的肺结核接受治疗性切除患者的病历。对临床信息和CT扫描的图像特征进行了调查和分析。89例成功接受VATS治疗性切除的患者中，46例在胸膜增厚（P＜0.001）、支气管周围淋巴结钙化（P＜0.001）、结核瘤（P = 0.015）、空洞（P = 0.006）和曲霉菌球（P = 0.038）方面分级明显较低；他们的术中失血量较少（171.0±218.7 vs 542.8±622.8 mL；P＜0.001），住院时间较短（5.2±2.2 vs 15.6±15.6天；P＜0.001）。他们的解剖性切除比例较低（73.9% vs 93.0%；P = 0.016），亚肺叶切除比例较高（56.5% vs 32.6%；P = 0.023），疾病复发率较低（4.3% vs 23.3%；P = 0.009）。38例成功接受VATS的耐多药肺结核（MDRTB）患者中，18例在胸膜增厚（P = 0.001）、支气管周围淋巴结钙化（P = 0.019）和空洞（P = 0.017）方面分级明显较低。他们术前用药时间较短（221.6±90.8 vs 596.1±432.5天；P = 0.001），亚肺叶切除较多（44.4% vs 10%），失血量较少（165.3±148.3 vs 468.0±439.9 mL；P = 0.009），住院时间较短（5.4±2.6 vs 11.8±6.9天；P = 0.001）。对于没有多个空洞、支气管周围淋巴结钙化和广泛胸膜增厚的患者，在选定的药物治疗失败的肺结核患者中可以安全地进行VATS治疗性切除，作为一种有效的辅助治疗方法，效果良好。
