Clinical outcomes for multi- and extensively drug resistant tuberculosis patients with adjunctive resectional lung surgery in Beijing, China
Clinical outcomes for multi- and extensively drug resistant tuberculosis patients with adjunctive resectional lung surgery in Beijing, China
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DOI：
10.21037/jtd.2017.02.54
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发表时间：
2017-03-01
影响因子：
2.5
通讯作者：
Gao, Weiwei
中科院分区：
文献类型：
--
作者：
Ma, Yan;Pang, Yu;Gao, Weiwei
本研究的目的是评估中国北京地区多药耐药（MDR-）和广泛耐药结核病（XDR-TB）患者的辅助性肺切除术的性能。1992年10月至2012年10月，21例MDR/XDR患者在北京胸科医院接受肺切除术。对耐多药和广泛耐药结核患者的临床结局进行3年手术随访分析。在本研究入组的21例患者中，20例患者（95.2%）患有单侧空洞性疾病，1例患者（4.8%）表现出双侧空洞性疾病。最常见的空洞位于左上肺（38.1%，8/21）。此外，19例（90.5%）行肺叶切除术，另2例（9.5%）因单侧肺上下野均存在明显空洞而行全肺切除术。随访3年，8例（38.1%）治愈，13例（61.9%）预后不良。在13例预后不良的患者中，5例（38.5%）死于结核病的进一步进展，8例（61.5%）复发。7例XDR-TB患者中仅有1例（14.3%）治愈，而14例MDR-TB患者中有7例（50.0%）治愈。总之，我们的数据表明，如果可行，应考虑在中国的MDR/XDRTB患者的手术治疗。二线药物的后续治疗可能在决定MDR/XDR-TB患者的最终临床结局方面发挥最重要的作用。
The objective of this study was to assess the performance of adjective resectional lung surgery for multidrug resistant (MDR-) and extensively drug resistant tuberculosis (XDR-TB) patients in Beijing, China. Between October 1992 and October 2012, 21 MDR/XDR patients undergoing pulmonary resection at Beijing Chest Hospital were enrolled in this study. The clinical outcomes of MDR-and XDR-TB patients were analyzed with a 3-year surgical follow-up. Out of 21 patients enrolled in this study, 20 patients (95.2%) had unilateral cavitary disease, and 1 patient (4.8%) exhibited bilateral cavitary disease. The most frequent cavitation was located in the left upper lung (38.1%, 8/21). In addition, 19 (90.5%) underwent lobectomy, and the other two (9.5%) underwent pneumonectomy due to obvious cavitation in both upper and lower fields of unilateral lung. After 3-year follow-up, eight patients (38.1%) were cured and 13 patients (61.9%) suffered from unfavorable outcomes. Of 13 patients with unfavorable outcomes, 5 patients (38.5%) died of further progression of TB disease, and 8 patients (61.5%) relapsed. Only 1 (14.3%) out of 7 XDR-TB patients was cured, compared with 7 (50.0%) out of 14 multidrug-resistant tuberculosis (MDR-TB) patients. In conclusion, our data demonstrate that if available, surgical treatment should be considered in MDR/XDRTB patients in China. The subsequent treatment with second-line drugs may play the most important role in determining the final clinical outcome for MDR/XDR-TB patients.