Clinical therapy evaluation of surgery on patients with multi-and extensively drug resistant tuberculosis / 中国综合临床

ABSTRACT

Objective To explore the clinical effect of surgery on treating multi-extensively drug resistant (MDR) and extensively drug resistant pulmonary (XDR) tuberculosis (M/XDR-PTB) in order to provide the new approach for patients with M/XDR-PTB.Methods The information of 75 cases with M/XDRPTB were recorded and they were underwent thoracic surgery at the National Tuberculosis Center in Tbilisi,Georgia from October 2008 to February 2011.Results Of 75 patients,52 cases were MDR and 23 were XDR with PTB underwent adjunctive thoracic surgery.The following surgical procedures were performed including pneumonectomy(10％),lobectomy (51％),segmentectomy (33％).Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 350 days.Mean postoperative follow up period was 372 days.Of 72 patients with complete outcomes information,59 (82％) had favorable outcomes including 90％ of MDR and 68％ of XDR-TB patients.No postoperative death occurred,7 patients (9％) had postoperative complications.Univariate analysis showed that,compared with good treatment outcomes,risk factors of poor treatment outcomes included cavitary disease (62％ vs.27％,P =＞ 0.02),probability of suffering from XDR (62％ vs.27％,P =0.02),positive preoperative sputum culture (77％ vs.14％,P＜ 0.001),acceptance of sensitive drugs(1.9％ vs.2.8％,P =0.03) and major postoperative surgical complication (23％ vs.5％,P =0.03).Conclusion Patients with M/XDR-PTB undergoing adjunctive thoracic surgery show with high rates of favorable outcomes,and no surgical related death as well as the low complications rates.Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.