Zhonghua Jie He He Hu Xi Za Zhi. 2023 Feb 12;46(2):111-120. doi: 10.3760/cma.j.cn112147-20221222-00986.
The cure rate of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis in the world is about 60%, and timely surgical intervention can increase the cure rate to more than 85%. The treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis requires multidisciplinary involvement of tuberculosis department, thoracic surgery department, imaging department, laboratory department and other disciplines to significantly reduce its morbidity and mortality. Although the World Health Organization has defined the role and status of surgery in the treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis, there are significant differences in the cognition and diagnosis and treatment methods of domestic clinicians on multidrug-resistant and rifampicin-resistant pulmonary tuberculosis. Therefore, it is urgent to develop expert consensus on surgical treatment of multidrug-resistant and rifampicin-resistant pulmonary tuberculosis for clinicians to learn from in clinical diagnosis and treatment practice. The Chinese Society for Tuberculosis,Chinese Medical Association organized experts in tuberculosis thoracic surgery to write the first draft of consensus based on the expert suggestion on surgical diagnosis and treatment of multidrug-resistant pulmonary tuberculosis written by the European Office of the World Health Organization in 2014 and the 2019 version of China's multidrug-resistant and rifampicin-resistant pulmonary tuberculosis expert consensus, and combined with China's national situation. This consensus systematically elaborated seven aspects, including surgical indications, contraindications to surgery, conditions and timing of surgery, surgical methods and indications of various surgical procedures, preoperative and postoperative chemotherapy, treatment of surgical complications, and perioperative management of patients with multidrug-resistant and rifampin-resistant pulmonary tuberculosis. After discussion and voting by experts, six recommendations were formed, aiming to provide reference for clinicians in the treatment of multidrug-resistant and rifampin-resistant pulmonary tuberculosis and further improve the standardized diagnosis and treatment level of multidrug-resistant and rifampin-resistant pulmonary tuberculosis in China.
全球耐多药和利福平耐药肺结核的治愈率约为60%，及时进行手术干预可将治愈率提高至85%以上。耐多药和利福平耐药肺结核的治疗需要结核科、胸外科、影像科、检验科等多学科参与，以显著降低其发病率和死亡率。虽然世界卫生组织已明确了手术在耐多药和利福平耐药肺结核治疗中的作用和地位，但国内临床医生对耐多药和利福平耐药肺结核的认识及诊治方法存在显著差异。因此，迫切需要制定耐多药和利福平耐药肺结核外科治疗的专家共识，供临床医生在临床诊治实践中借鉴。中华医学会结核病学分会组织结核病胸外科专家，依据世界卫生组织欧洲办事处2014年编写的耐多药肺结核外科诊治专家建议及2019版中国耐多药和利福平耐药肺结核专家共识，并结合我国国情，撰写了共识初稿。该共识系统阐述了耐多药和利福平耐药肺结核的手术适应证、手术禁忌证、手术条件及时机、各种手术方式的手术方法及适应证、术前和术后化疗、手术并发症的处理以及患者围手术期管理等七个方面。经专家讨论和投票，形成了六条推荐意见，旨在为临床医生治疗耐多药和利福平耐药肺结核提供参考，进一步提高我国耐多药和利福平耐药肺结核的规范化诊治水平。
