Ose Naoko, Takeuchi Yukiyasu, Kitahara Naoto, Matumura Akihide, Kodama Ken, Shiono Hiroyuki, Susaki Yoshiyuki, Funakoshi Yasunobu, Takabatake Hiroyuki, Shintani Yasushi
Osaka University Graduate School of Medicine, Department of General Thoracic Surgery, Suita-shi, Osaka, Japan.
Osaka Toneyama Medical Center, Department of General Thoracic Surgery, Toyonaka-shi, Osaka, Japan.
J Thorac Dis. 2021 Feb;13(2):977-985. doi: 10.21037/jtd-20-3108.
Solitary pulmonary nodules caused by nontuberculous mycobacteriosis are included as a category of pulmonary nontuberculous mycobacterium disease. Clinical characteristics, treatments and prognosis are not fully known because there are a few related reports.
This was a multi-center retrospective study of 101 cases diagnosed as solitary nodular type of nontuberculous mycobacteriosis from January 2000 to March 2017 that underwent resection at 9 related facilities belonging to the Thoracic Surgery Study Group of Osaka.
The most common pathogen was (n=77, 87.5%), followed by (n=8, 9.1%). Chest computed tomography results showed subpleural locations that were difficult to distinguish from lung cancer. Fluorodeoxyglucose positron emission tomography/computed tomography was performed in 58 cases and positive results were obtained in 35 (60.3%), with an average maximum standardized uptake value of 3.87. The purpose of resection in most cases was for diagnosis. The surgical procedure was wedge resection in 87, segmentectomy in 3, and lobectomy in 11, while 77 underwent thoracoscopic surgery. Postoperative complications occurred in 7 cases, though no infections caused by nontuberculous mycobacteriosis were noted. The median observation period was 27 months. A worsened condition occurred in 10 (9.9%) with , though none had local recurrence.
Solitary pulmonary nodules due to nontuberculous mycobacteriosis is difficult to diagnose based on preoperative examination results or distinguish from lung cancer. Among the present cases, none had local complications or recurrence, even in those that underwent a wedge resection, thus postoperative chemotherapy was not considered necessary if a complete resection was performed. On the other hand, some cases showed reinfection after a long period following resection, thus patients should be informed of that future possibility.
非结核分枝杆菌病所致孤立性肺结节被纳入肺非结核分枝杆菌病范畴。由于相关报道较少，其临床特征、治疗方法及预后尚不完全清楚。
这是一项多中心回顾性研究，对2000年1月至2017年3月期间在大阪胸外科研究组所属的9家相关机构接受手术切除的101例诊断为非结核分枝杆菌病孤立结节型的病例进行了研究。
最常见的病原体是 （n = 77，87.5%），其次是 （n = 8，9.1%）。胸部计算机断层扫描结果显示胸膜下位置，难以与肺癌区分。58例患者进行了氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描，35例（60.3%）结果为阳性，平均最大标准化摄取值为3.87。大多数病例的手术目的是诊断。手术方式为楔形切除术87例，节段切除术3例，肺叶切除术11例，77例接受了胸腔镜手术。7例发生术后并发症，但未发现非结核分枝杆菌病引起的感染。中位观察期为27个月。10例（9.9%）患者病情恶化， ，但均无局部复发。
非结核分枝杆菌病所致孤立性肺结节难以根据术前检查结果进行诊断，也难以与肺癌区分。在目前的病例中，即使是接受楔形切除术的患者也没有局部并发症或复发，因此如果进行了完整切除，术后化疗被认为没有必要。另一方面，一些病例在切除后很长一段时间出现再次感染，因此应告知患者未来有这种可能性。
