Pulmonary resection in the treatment of 43 patients with well-localized, cavitary pulmonary multidrug-resistant tuberculosis in Shanghai
Pulmonary resection in the treatment of 43 patients with well-localized, cavitary pulmonary multidrug-resistant tuberculosis in Shanghai
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上海肺切除术治疗43例局限性空洞型耐多药肺结核
DOI：
10.1093/icvts/ivt251
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发表时间：
2013-09-01
影响因子：
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通讯作者：
Jiang, Gening
中科院分区：
文献类型：
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作者：
Xie, Boxiong;Yang, Yang;Jiang, Gening
目的：耐多药结核病（MDR-TB）是指在体外至少对异烟肼和利福平产生耐药性的结核病，对全球结核病控制构成重大挑战。尽管全球努力控制结核病，但它仍然是传染性病原体导致死亡的主要原因。虽然现代结核病的治疗依赖于化疗，手术是接受作为辅助治疗耐多药tuberculosis.METHODS：在一项回顾性队列研究，43例耐多药结核病患者（28名男性和15名女性：平均年龄45.3岁）谁接受肺切除术1993年1月至2011年12月进行了审查。每一个有良好的局限性，空洞病变的患者术前均表现为阳性。在审查患者的病史和药物敏感性结果后，在每周一次的工作人员会议上选择个性化的治疗方案。通过多元回归分析确定影响治疗结果的变量。结果：无手术死亡率。40例（93.0%）患者术后痰菌转阴和/或保持阴性。每例患者均完成了治疗，在平均81个月（范围18-214个月）的随访期间，1例患者复发。该患者经另一疗程治疗后痊愈。手术方式包括肺叶切除30例（69.8%），双叶切除2例（4.7%），全肺切除8例（18.6%），肺叶加肺段切除3例（6.98%）。无手术相关死亡，有5例主要术后并发症（11.6%）。总体而言，43名耐多药结核病患者中有40名（93.0%）在手术后仍然没有感染结核病。术前化疗时间与术后疗效相关（P = 0.001）。结论：选择合适的患者，早期手术治疗，可提高肺空洞局限性好的耐多药肺结核的治疗成功率。
OBJECTIVES: Multidrug-resistant tuberculosis (MDR-TB), defined as tuberculosis resistant to at least isoniazid and rifampicin in vitro, poses a significant challenge to the control of TB worldwide. Despite global efforts to control tuberculosis, it remains the leading cause of death from an infectious agent. Although modern tuberculosis treatment relies on chemotherapy, surgery is accepted as adjuvant treatment for multidrug-resistant tuberculosis.METHODS: In a retrospective cohort study, 43 MDR-TB patients (28 males and 15 females: mean age 45.3 years) who underwent pulmonary resection between January 1993 and December 2011 were reviewed. Every patient with well-localized, cavitary lesions showed sputum-positive preoperatively. Individually tailored treatment regimens were selected at a once-weekly staff conference following review of the patient's case history and drug susceptibility results. The variables that affected treatment outcomes were identified through multivariate regression analysis.RESULTS: There was no surgical mortality. Forty (93.0%) patients demonstrated sputum conversion and/or remained negative after surgery. Each patient had completed treatment, and during a mean of 81 follow-up months (range 18-214 months), 1 patient relapsed. This patient was cured after another course of treatment. Operative procedures included 30 (69.8%) lobectomies, 2 (4.7%) bilobectomies, 8 (18.6%) pneumonectomies and 3 (6.98%) lobectomies plus segmentectomy. There were no operation-related deaths, and there were five major postoperative complications (11.6%). Overall, 40 of 43 (93.0%) MDR-TB patients remained free of TB following surgery. The duration of chemotherapy before surgery had correlation with postoperative outcome (P = 0.001).CONCLUSIONS: The proper selection of the patients and early decision for surgical intervention can achieve a high success rate of pulmonary MDR-TB with well-localized pulmonary cavities.