Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema / 中华外科杂志

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ2 test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ2=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ2=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ2=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.

Cirugía de resección pulmonar como tratamiento coadyuvante para la curación de los pacientes con TBC-MDR en el Hospital Nacional Hipólito Unanue 2006-2010 / Surgery of pulmonary resection as coadjuvant therapy for the cure of patients with TB-MDR at the National Hospital Hipolito Unanue 2006-2010

OBJETIVO: Determinar los porcentajes de curación obtenidos en los pacientes con tuberculosis multidrogorresiste que fueron sometidos a cirugía de resección pulmonar en el servicio de cirugía de Tórax del HNHU. METODOLOGIA: El presente es un estudio observacional de tipo descriptivo y correlacional, siendo el diseño correspondiente transversal en razón del tiempo implicado en la medición de las variables. La población de estudio está conformada por pacientes que presentaban el diagnóstico de TBC MDR sometidos a cirugía de resección pulmonar en el Hospital Nacional Hipólito Unanue en el periodo comprendido entre el 2006 y el 2010. RESULTADOS: El presente estudio se realizó con una población de 25 pacientes de los cuales 13 (52 por ciento) fueron del sexo femenino y 12 (48 por ciento) del sexo masculino. El lugar de procedencia más frecuente fue el agustino 08 (32 por ciento) y San Juan de Lurigancho 06 (24 por ciento). Las cirugías de resección pulmonar más frecuente fueron: lobectomía superior derecha 10 (40 por ciento), Neumonectomía izquierda 06 (24 por ciento) y Neumonectomía derecha 04 (16 por ciento). Dentro de las complicaciones posoperatorias inmediatas encontramos: Hemorragia 03 (12 por ciento), Bronconeumonía aspirativa 04 (16 por ciento). Las complicaciones postoperatorias tardías fueron: fistula broncopleural asociado a empiema: 04 (16 por ciento), empiema 02 (8 por ciento), Fuga aérea prolongada 03 (12 por ciento). Los tipos de lesiones radiológicas más frecuentes fueron: Lesiones cavitadas localizadas 14 (56 por ciento) y lesiones con destrucción pulmonar 06 (24 por ciento). CONCLUSION: El tratamiento quirúrgico de resección pulmonar asociado con la quimioterapia antituberculosa para pacientes multidrogorresistentes proporciona una evolución favorable comparada con la administración de solamente la terapia farmacológica.

Cirugía pulmonar en tuberculosis / Surgery for pulmonary tuberculosis: Review of 33 operated patients

Background: Surgical treatment for pulmonary tuberculosis is mainly ¡imited to the management of sequelae such as bronchiectasis, hemoptysis and brochopleural fistulae. Aim: To review the data of patients who underwent surgical treatment for pulmonary tuberculosis. Material and methods: Retrospective review of 33 patients aged 18 to 73 years (24 males) who underwent lung resection surgery for the management of pulmonary tuberculosis. Follow-up data were obtained from outpatient visit records and registries of the national tuberculosis program. Results: The reasons to perform surgery were the following: fifteen for hemoptysis, nine for lung destruction and nine for an active and multiresistant disease. No patient died in the postoperative period. The morbidity observed included empyema (n =5), pneumothorax (n =2), bronchopleural fístula (n =2) and hemothorax (n =2). At six months offollow up, six of the nine patients with active tuberculosis had negative acid-fast bacilli on sputum smear. Two of these patients died, one due to respiratory failure and another by an unrelated cause. Both dead patients had negative acid-fast bacilli on sputum smear. Conclusions: Surgery in pulmonary tuberculosis has a high rate of complications butmay be usefulin selected patients.

Surgical treatment of multirresistant lung tuberculosis

The medical treatment of tuberculosis with chemotherapy has a rate of failure near 2 por cento, associated with drugs resistance of first, second and third line regimens. In such cases, lung resection plays a significant role as an adjuvant method in treating it by resection of localized lesions, so is possible to decrease the pool of bacilli and then improve the drug response. In a retrospective review of 139 patients with multirresistant pulmonary tuberculosis between 1980 and 1990 32 cases were operated on. There were 17 men and 15 women all of them infected by mycobacterium tuberculosis resistant to rifampin and isoniazid. The resections performed were: pneumonectomy in 14 cases, lobectomy in 13 and segmentectomy in 5. The operative mortality was 6.2 por cento. The postoperative follow-up to 18 months showed a negative sputum culture in 90 por cento of the survivors and the others relapsed after the initial conversion. The results of this study show a high rate of conversion in patients with multiresistant tuberculosis treated with resective lung surgery