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Surgical Treatment of Complications of Pulmonary Tuberculosis, including Drug-Resistant Tuberculosis

机译：肺结核并发症（包括耐药结核）的外科治疗

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Surgery for drug-resistant tuberculosis has been shown to be safe and effective, with similar level of mortalities associated with surgical intervention observed with that for lung cancer. While surgery has been an option to treat TB in the pre-antibiotic era, it is now increasingly used to treat complications of pulmonary TB, particularly in patients with drug-resistant TB who do not respond to medical treatment. The two most frequent indications for lung resection in drug- resistant TB, are i) failed medical treatment with persistent sputum positivity or ii) patients who have had medical treatment and are sputum negative, but with persistent localized cavitary disease or bronchiectasis. Massive hemoptysis is a potentially life-threatening complication of TB. Lung resection is potentially curative in patients with massive hemoptysis and cavitary or bronchiectatic disease. Bronchial artery embolization in these patients has a high success rate but bears also the risk of recurrence. Lung resection can be safely undertaken in selected patients with HIV co-infection and pulmonary complications of TB. Ambulatory drainage is a novel, safe, affordable and effective method of draining a chronic TB associated empyema thoracis. We review here the current surgical treatment of the complications of pulmonary TB and discuss the experience from the Durban Cardiothoracic Surgery Unit for the surgical treatment of patients with complicated pulmonary TB.
机译：耐药结核病的手术已被证明是安全有效的，死亡率与肺癌的手术干预相似。尽管在前抗生素时代，外科手术已成为治疗结核病的一种选择，但如今它已被越来越多地用于治疗肺结核的并发症，特别是在对药物无反应的耐药结核患者中。耐药结核病中肺切除的两个最常见指征是：i）持续痰阳性的药物治疗失败;或ii）接受过药物治疗且痰阴性的患者，但持续存在局部性空洞疾病或支气管扩张。大量咯血可能是威胁生命的结核病并发症。患有大咯血和空洞或支气管扩张疾病的患者，肺切除术可能具有治愈作用。这些患者的支气管动脉栓塞成功率很高，但也有复发的风险。 HIV合并感染和肺部肺部并发症的部分患者可以安全地进行肺切除。动态引流是引流慢性结核相关脓胸的一种新颖，安全，可负担和有效的方法。我们在这里回顾当前肺结核并发症的外科治疗方法，并讨论德班心胸外科部门对复杂肺结核患者进行手术治疗的经验。

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