Surgery for Pulmonary Tuberculosis

Abstract

During the period 1990 -1994 a total of 578 operations were performed in 502 patients with various forms of tuberculosis. Most of the patients (68%) were men aged 20 to 50 years (70%). Sputum cultures were positive in 55% of the patients. More than half of all patients were chronic smokers, and about 10% were alcoholics or drug addicts. There were no human immunodeficiency virus-infected patients, and none with acquired immunodeficiency syndrome. The most frequent surgical interventions were, according to the classification adopted in Russia, for cavernous or fibrocavernous tuberculosis (196 cases) and tuberculomas (161 cases). The main operative procedures used were pulmonary resection (n ‫؍‬ 280) and pneumonectomy or pleuropneumonectomy (n ‫؍‬ 80). Diseased intrathoracic lymph nodes were ablated in 62 patients. Thoracoplasty or thoracomyoplasty were performed in 46 cases, thoracostomy in 37, closure of a thoracic wall defect in 27, and reamputation of the main bronchial stump in 6. Postoperative complications arose in 20% of the patients. More than half occurred in the pleural cavity or bronchi and were associated with tuberculous infection. The postoperative hospital casefatality rate was 2%. The overall clinical efficacy by the time of discharge was 82.7% (95% in tuberculomas). Reactivation of tuberculosis over the first 3 years after discharge occurred in 6.6% of the patients. Most patients with large or multiple caverns, tuberculomas, intrathoracic caseous lymphadenitis, or various complications of pulmonary tuberculosis cannot be cured (or are not amenable to cure in principle) by means of antibacterial therapy because of irreversible morphologic changes in the lungs, bronchi, pleura, lymph nodes, or thoracic wall. For this reason, indications for surgical management of pulmonary tuberculosis should be generally expanded. Excessively long antibacterial therapy for tuberculosis is often inadvisable. Although the availability of standardized regimens of antibacterial therapy is strategically essential, each patient must be treated according to an individual plan. In certain cases thoracic surgeons should be enlisted to participate in the development of such plans.

Impaired Expression of Perforin and Granulysin in CD8+T Cells at the Site of Infection in Human Chronic Pulmonary Tuberculosis

“…In the cohort of patients with verified chronic pulmonary TB infection, the clinical form of TB was diagnosed as either cavitary TB (Ͼ3-cm cavern with a fibrotic capsule formed; n ϭ 10) or noncavitary TB (multiple tuberculomas or infiltrative TB; n ϭ 9) ( Table 1). Cavitary TB was considered to include extensive tissue destruction with formation of a fibrotic cavern, whereas noncavitary TB included limited fibrotic processes (44). In situ imaging of cryopreserved tissue sections was performed with lung biopsies from the TB lesions, as well as from the macroscopically normal distal lung parenchyma.…”

“…Surgical treatment of TB in Russia is performed when the patient fails to respond to conventional treatment with first-and/or second-line drugs due to irregular use of anti-TB drugs and/or development of multidrug-resistant TB. In Russia, excessively long treatment with anti-TB drugs is generally not recommended, and therefore patients with multiple caverns or tuberculomas who cannot be efficiently cured by means of chemotherapy are often given surgical treatment (44). Upon thoracic surgery, areas of damaged and fibrotic tissue are removed in order to decrease the mycobacterial load and thus prevent disease progression.…”

Endobronchial valve treatment of destructive multidrug-resistant tuberculosis

“…These operative methods invariably present some risk to the patient, and patients suffer cosmetic defects in the postoperative period. 19 A significant number of patients consequently refuse surgical management. Minimally invasive and/or drug-free treatment methods are therefore being investigated to explore options for complementary therapy methods to improve treatment outcomes.…”

Recent advances in the management of pulmonary tuberculoma with focus on the use of tubeless video-assisted thoracoscopic surgery

“…In 1997, Perelman et al (19) reported 161 surgical pulmonary tuberculoma cases. The choice of operation, wedge or lobectomy, was dependent on the anatomy of the tuberculoma.…”