Division of Respirology, Department of Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Division of Thoracic Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G2C4, Canada.
Respir Med. 2018 Sep;142:1-6. doi: 10.1016/j.rmed.2018.07.003. Epub 2018 Jul 9.
Lung resection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is considered when medical therapy alone fails to provide long term control. Data regarding comparative and long-term outcomes are limited. We aimed to review indications and outcomes of adjuvant lung resection for NTM-PD compared with controls.
We retrospectively studied 27 surgically treated patients, matched 1:1 for age, sex, NTM species, and radiologic pattern of disease, with control patients treated exclusively with antibiotics.
In the surgical group, the median (IQR) age was 55 (49-61) years and 74.1% were female. Eighteen patients had Mycobacterium avium complex, and 9 had M. xenopi. Operations included 8 pneumonectomies, 20 lobectomies, one segmentectomy and one lobectomy plus segmentectomy. Post-surgical complications occurred in 6 patients (20%), including 2 acute respiratory distress syndrome, 1 bronchopleural fistula, 1 pericardial tamponade, and 2 empyema. Complications were more common among patients operated upon for progressive disease despite medical therapy (OR 10, p = 0.025). Of 24 matched pairs followed for ≥1 year, sustained culture conversion was observed in 21 (87.5%) patients in the surgical group and in 11 (45.8%) patients in the non-surgical group (RR 2.36, 95%CI 1.37-4.03, p = 0.002). Median (IQR) percentage of follow-up time on antibiotics was 14% (0-100%) in the surgical group and 83% (10.8%-100%) in the non-surgical group (p = 0.195) during a median (IQR) follow-up of 16 (2-36) months.
NTM-PD patients who underwent adjuvant lung resection experienced significant morbidity and more frequently achieved sputum culture conversion. Long term antibiotic requirements may have been reduced.
当单纯药物治疗无法长期控制时，会考虑对非结核分枝杆菌肺病（NTM-PD）患者进行肺切除术。关于比较和长期结果的数据有限。我们旨在回顾辅助肺切除术治疗 NTM-PD 与对照组的适应证和结果。
我们回顾性研究了 27 例接受手术治疗的患者，这些患者按年龄、性别、NTM 物种和疾病的影像学模式与对照组 1:1 匹配，对照组仅接受抗生素治疗。
在手术组中，中位（IQR）年龄为 55（49-61）岁，74.1%为女性。18 例为鸟分枝杆菌复合体，9 例为 X 分枝杆菌。手术包括 8 例全肺切除术、20 例肺叶切除术、1 例肺段切除术和 1 例肺叶切除术加肺段切除术。6 例（20%）患者发生术后并发症，包括 2 例急性呼吸窘迫综合征、1 例支气管胸膜瘘、1 例心包填塞和 2 例脓胸。在因药物治疗后疾病进展而接受手术的患者中，并发症更为常见（OR 10，p=0.025）。在 24 对至少随访 1 年的匹配对中，手术组有 21 例（87.5%）患者持续培养转阴，非手术组有 11 例（45.8%）患者持续培养转阴（RR 2.36，95%CI 1.37-4.03，p=0.002）。手术组在抗生素治疗期间的中位（IQR）随访时间为 14%（0-100%），而非手术组为 83%（10.8%-100%）（p=0.195），中位（IQR）随访时间为 16（2-36）个月。
接受辅助肺切除术的 NTM-PD 患者经历了显著的发病率，并且更频繁地实现痰培养转阴。长期抗生素需求可能减少。
