Kim Joong-Yub, Lee Hyun Woo, Yim Jae-Joon, Kwak Nakwon
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Chest. 2023 Apr;163(4):763-777. doi: 10.1016/j.chest.2022.09.037. Epub 2022 Oct 5.
The burden of nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasing worldwide. Amidst the poor treatment success of antibiotic therapy, adjunctive surgery is gaining attention; however, discrepancies in reported outcomes exist.
What are the treatment outcomes and complications of patients with NTM-PD undergoing adjunctive surgery?
The MEDLINE, Embase, and Cochrane databases were searched for eligible studies before January 2022. Studies reporting the outcomes of adjunctive surgery in adult patients who satisfied the diagnostic criteria for NTM-PD were included. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Data were extracted by two independent observers. Estimates of proportion were pooled using a random-effects model. Sputum mycobacterial culture negative conversion, recurrence, complications, and in-hospital mortality after surgery were primary outcomes that had been set before data collection began. Heterogeneity was evaluated by using the I statistic, and publication bias was assessed by using funnel plots and the Egger test.
Fifteen of the 2,739 screened studies, with 1,071 patients, were assessed. The weighted proportion of postoperative sputum culture negative conversion was 93% (95% CI, 87%-97%), and recurrence was 9% (95% CI, 6%-14%) for a median follow-up of 34 months. The proportion of patients who experienced postoperative complications was 17% (95% CI, 13%-23%), and in-hospital mortality was 0% (95% CI, 0%-2%). Studies that performed multilobar lung resection in > 30% of the study population showed comparable rates of complications with studies that did not.
Adjunctive surgery is an effective therapeutic option with acceptable rates of complications for selected patients with NTM-PD.
PROSPERO; No.: CRD42022310663; URL: https://www.crd.york.ac.uk/prospero/.
非结核分枝杆菌肺病（NTM-PD）的负担在全球范围内不断增加。在抗生素治疗效果不佳的情况下，辅助手术正受到关注；然而，报告的结果存在差异。
接受辅助手术的NTM-PD患者的治疗结果和并发症是什么？
在2022年1月之前检索MEDLINE、Embase和Cochrane数据库以查找符合条件的研究。纳入报告符合NTM-PD诊断标准的成年患者辅助手术结果的研究。本研究遵循系统评价和Meta分析报告的首选项目报告指南。数据由两名独立观察员提取。使用随机效应模型汇总比例估计值。痰分枝杆菌培养阴性转化、复发、并发症和术后住院死亡率是在数据收集开始前设定的主要结果。使用I统计量评估异质性，并使用漏斗图和Egger检验评估发表偏倚。
在筛选的2739项研究中，有15项研究、1071例患者被评估。术后痰培养阴性转化的加权比例为93%（95%CI，87%-97%），中位随访34个月时复发率为9%（95%CI，6%-14%）。术后发生并发症的患者比例为17%（95%CI，13%-23%），住院死亡率为0%（95%CI，0%-2%）。在超过30%的研究人群中进行多叶肺切除术的研究与未进行多叶肺切除术的研究并发症发生率相当。
辅助手术是一种有效的治疗选择，对于选定的NTM-PD患者，并发症发生率可接受。
PROSPERO；编号：CRD42022310663；网址：https://www.crd.york.ac.uk/prospero/ 。
