Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Chung University, Tainan, Taiwan.
Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
J Microbiol Immunol Infect. 2023 Oct;56(5):1064-1072. doi: 10.1016/j.jmii.2023.07.006. Epub 2023 Jul 28.
Multidrug-resistant tuberculosis (MDR-TB) requires extended treatment with regimens with multiple side effects, resulting in high treatment failure rates. Adjunctive lung resection combined with anti-tubercular agents improves outcomes. However, few studies have evaluated the potential harm from surgery and determined the optimal conditions for surgery. We aimed to analyze perioperative conditions to assess risk factors for postoperative complications in a multi-institutional setting.
This retrospective study included 44 patients with MDR-TB who underwent adjunctive lung resection at three management groups of the Taiwan MDR-TB consortium between January 2007 and December 2020. Demographic data, clinical characteristics, radiological findings, sputum culture status before surgery, primary or acquired drug resistance, surgical procedure, complications, and treatment outcomes were collected and analyzed. Multivariate logistic regression was used to identify risk factors for postoperative complications.
Twenty-seven patients (61.4%) underwent lung resection using video-assisted thoracic surgery (VATS). The overall surgical complication rate was 20.5%, and the surgical mortality rate was 9.1%. Postsurgical hemothorax was the most common complication (11.4%). According to the univariate analysis, hilum involvement in images, positive preoperative sputum culture, and thoracotomy approach were unfavorable factors. VATS approach [adjusted OR, 0.088 (95% CI, 0.008-0.999)] was the only favorable factor identified by multivariate analysis.
The minimally invasive approach is a growing trend, and lobectomies and sublobar resections were the main procedures for MDR-TB. The VATS approach significantly reduced the surgical complication rate. Postsurgical hemothorax was noteworthy, and meticulous hemostasis of the chest wall and residual lung surface is critical for successful resections.
耐多药结核病（MDR-TB）需要采用具有多种副作用的方案进行长期治疗，导致治疗失败率较高。辅助性肺切除术联合抗结核药物可改善治疗效果。然而，很少有研究评估手术带来的潜在危害，并确定手术的最佳条件。我们旨在分析围手术期情况，以评估多机构环境下术后并发症的危险因素。
本回顾性研究纳入了 2007 年 1 月至 2020 年 12 月期间，台湾耐多药结核病联合会的三个管理组中 44 例接受辅助性肺切除术的 MDR-TB 患者。收集并分析了人口统计学数据、临床特征、影像学发现、手术前痰培养状况、原发性或获得性药物耐药性、手术方式、并发症和治疗结果。采用多变量逻辑回归分析确定术后并发症的危险因素。
27 例患者（61.4%）采用电视辅助胸腔镜手术（VATS）进行肺切除术。总的手术并发症发生率为 20.5%，手术死亡率为 9.1%。术后血胸是最常见的并发症（11.4%）。根据单因素分析，影像学上的肺门受累、术前痰培养阳性和开胸手术方式是不利因素。VATS 方法[调整后的优势比（OR），0.088（95%可信区间，0.008-0.999）]是多变量分析中唯一确定的有利因素。
微创手术是一种不断发展的趋势，肺叶切除术和亚肺叶切除术是 MDR-TB 的主要手术方式。VATS 方法显著降低了手术并发症发生率。术后血胸值得关注，仔细止血胸壁和残肺表面对于成功切除至关重要。
