关键词: 结核, 外科手术, 结核杆菌, 肺切除术, 药物耐受性, 肺, 叶切除术

Abstract:

Objective To analyze the effect of surgical treatment on the patients with multi-drug resistant pulmonary tuberculosis. Methods  A retrospective analysis of the clinical data and follow-up Results were performed on a total of 42 patients with multi-drug resistant pulmonary of tuberculosis in our hospital from January 2009 to June 2016. These 42 patients underwent different surgery procedures, included single lobectomy in 17 cases, multiple lobectomy in 15 cases, Pneumonectomy in 5 cases, completion pneumonectomy in 2 cases and segmentectomy in 2 cases. Results  One patient with single lobectomy and one patient with segmentectomy were lost after one month of follow-up. And 40 patients were followed up for one to 84 months （26 ± 24.8 months）. For the rest 40 patients, the treatment success rate, remission rate, failure rate were 80.0%（32/40）, 7.5%（3/40）, 12.5%（5/40, including 3 death patients）respectively. They were 16/16, 0 respectively in single lobectomy patients ; 11/15, 2/15, 2/15 respectively in multiple lobectomy patients; 3/5, 1/5, 1/5 respectively in pneumonectomy patients; 2/3, 0, 1/3 respectively in completion pneumonectomy patients; 1/1, 0, 0 respectively in segmentectomy patients. The incidence of complication was 35.0%（14/40）. The complications included intractable cavity（12.5%, 5/40）, bronchopleural fistula（12.5%, 5/40）, pleural infection（5.0%, 2/40）, pleural active bleeding（2.5%, 1/40）and incision infection（2.5%, 1/40）. The complication proportions in the five surgical procedures were 2/16, 8/15, 2/5, 2/3, 0 respectively. Conclusion Surgery is helpful to improve the treatment success rate for patients with multi-drug resistant pulmonary tuberculosis. Single lobectomy should be the preferred surgical procedure for the single lobe lesions. For the multiple lobectomy, surgical complications should be prevented.

Key words: pulmonary, drug-resistant, lobectomy, tuberculosis, surgery, pneumectomy, mycobacterium tuberculosis