Sakane Tadashi, Matsuoka Katsunari, Kumata Sakiko, Watanabe Risa, Yamada Tetsu, Matsuoka Takahisa, Nagai Shinjiro, Ueda Mitsuhiro, Miyamoto Yoshihiro
Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan.
J Thorac Dis. 2018 Feb;10(2):954-962. doi: 10.21037/jtd.2018.01.60.
The number of cases of nontuberculous mycobacterial (NTM) lung disease has been increasing in recent years, and the efficacy of surgical treatment has been recognized. We investigated the clinical characteristics and behavior of NTM lung disease and analyzed the outcomes of surgery.
The data of 25 patients who underwent anatomical resection for NTM lung disease in our institution between January 2004 and December 2014 were retrospectively examined.
The patients included 10 men and 15 women (mean age, 63.1 years). Twenty patients had , and 5 had . The indications for lung resection in 20 definitively diagnosed patients included a remaining or worsening lesion despite medical treatment (n=16), massive hemoptysis or bloody sputum (n=5), and prolonged smear positivity (n=1); multiple reasons were allowed. In five cases without a definitive diagnosis, surgery was performed due to the suspicion of lung cancer. The surgical procedures included pneumonectomy, n=4; lobectomy, n=13; and segmentectomy, n=8. Complete resection was achieved in 10 cases (40.0%). Video-assisted thoracoscopic surgery (VATS) was performed in 17 cases (68.0%), especially in 6 of 8 cases (75.0%) that underwent segmentectomy and in 10 of 11 cases (90.9%) that received simple lobectomy. There was one case of hospital mortality. Among the 22 patients who were followed at our institution, relapse occurred in 4 patients, and new infection occurred in 1 patient. NTM lung disease was controlled in 17 patients (77.3%). In the four cases that relapsed, the median relapse-free interval was 29.5 months.
Surgical resection was a feasible treatment for NTM lung disease and was associated with favorable outcomes, although there was 1 case of hospital mortality. VATS procedures were considered adequate for the treatment of NTM lung disease; however, the surgical indications must be carefully considered.
近年来，非结核分枝杆菌（NTM）肺病的病例数不断增加，手术治疗的疗效已得到认可。我们调查了NTM肺病的临床特征和行为，并分析了手术结果。
回顾性研究了2004年1月至2014年12月间在我院接受解剖性切除治疗NTM肺病的25例患者的数据。
患者包括10名男性和15名女性（平均年龄63.1岁）。20例患者患有[此处原文缺失具体病症]，5例患有[此处原文缺失具体病症]。20例确诊患者的肺切除指征包括尽管接受了药物治疗但病灶仍残留或恶化（n = 16）、大量咯血或血痰（n = 5）以及涂片持续阳性（n = 1）；允许多种原因并存。在5例未明确诊断的病例中，因怀疑肺癌而进行了手术。手术方式包括全肺切除术（n = 4）、肺叶切除术（n = 13）和肺段切除术（n = 8）。10例（40.0%）实现了完全切除。17例（68.0%）采用了电视辅助胸腔镜手术（VATS），特别是在8例肺段切除术中的6例（75.0%）以及11例单纯肺叶切除术中的10例（90.9%）。有1例医院死亡病例。在我院随访的22例患者中，4例复发，1例发生新感染。17例患者（77.3%）的NTM肺病得到控制。在4例复发病例中，无复发的中位间隔时间为29.5个月。
手术切除是治疗NTM肺病的一种可行方法，尽管有1例医院死亡病例，但结果良好。VATS手术被认为适用于NTM肺病的治疗；然而，必须仔细考虑手术指征。
