Nelson K G, Griffith D E, Brown B A, Wallace R J
Department of Surgery, The University of Texas Health Center, Tyler 75710, USA.
Ann Thorac Surg. 1998 Aug;66(2):325-30. doi: 10.1016/s0003-4975(98)00401-9.
Although operation remains part of the management of Mycobacterium avium-intracellulare lung disease, few series have assessed operation in the era of better therapeutic drugs (especially clarithromycin).
From January 1, 1989, through June 30, 1997, 28 patients with M avirum-intracellulare lung disease underwent pulmonary resection. All were receiving multidrug therapy (17 of 28 were receiving clarithromycin) before and after operation. Eight patients underwent pneumonectomy (6 right, 2 left); 20 patients underwent partial resections including 18 with upper lobe lobectomies (14 right, 4 left). The most common indications for operation were medical treatment failure (15) and as part of initial therapy (9).
Mean postoperative follow-up was 39 months. Complications occurred in 9 of 28 patients (32%), and included persistent air leak requiring surgical correction (5), early postoperative death (2), and late bronchopleural fistulae (1 patient). Twenty-three of 26 patients were known to be acid fast bacilli culture negative within 1 month of operation. Only 1 of 26 patients who survived 2 years is known to have had a relapse.
Operation continues to play an important role in treatment of M avium-intracellulare lung disease. More than 90% of patients become culture negative and remain so when they continue to receive drugs. Although morbidity is relatively high, it is manageable and the 12-month mortality in the current series was low (7%).
虽然手术仍是鸟分枝杆菌复合群肺病治疗的一部分，但在有更好治疗药物（尤其是克拉霉素）的时代，很少有系列研究评估手术治疗效果。
从1989年1月1日至1997年6月30日，28例鸟分枝杆菌复合群肺病患者接受了肺切除术。所有患者在手术前后均接受多药治疗（28例中有17例接受克拉霉素治疗）。8例患者接受了全肺切除术（6例右肺，2例左肺）；20例患者接受了部分切除术，其中包括18例上叶切除术（14例右肺，4例左肺）。最常见的手术指征是药物治疗失败（15例）和作为初始治疗的一部分（9例）。
术后平均随访39个月。28例患者中有9例（32%）发生并发症，包括需要手术纠正的持续性漏气（5例）、术后早期死亡（2例）和晚期支气管胸膜瘘（1例）。26例患者中有23例在术后1个月内痰抗酸杆菌培养转阴。26例存活2年的患者中只有1例复发。
手术在鸟分枝杆菌复合群肺病治疗中继续发挥重要作用。超过90%的患者培养转阴，继续接受药物治疗时保持转阴状态。虽然发病率相对较高，但可以控制，本系列研究中12个月死亡率较低（7%）。
