Surgery for Pleuropulmonary Tuberculosis
Keywords:Tuberculosis. Tuberculosis, Pulmonary. Antitubercular Agents. Tuberculosis, Pleural. Empyema, Tuberculous. Tuberculosis, Multidrug-Resistant. Tuberculoma. Rifampin. Tuberculosis, Urogenital.
The purpose of our study was to analyze current indications for surgery in pleuropulmonary tuberculosis (TB). We present our experience with TB patients presenting with indications for surgery between 1998 and 2003. Material and Methods: The indications for surgical intervention included 220 cases of empyema, mediastinal lymphadenopathy 48 cases, hemoptysis 25 cases, destroyed lung 24 cases, undiagnosed pleural effusion 24 cases, bronchiectasis 18 cases, cavitary lesion with MDRTB 13 cases and pulmonary aspergilloma 10 cases. Thirteen patients with multidrug-resistant tuberculosis required surgical intervention, although 26 were treated with second line drugs during this period. Results: The techniques utilized included decortication in 152 cases, lobectomy in 62 cases, rib resection for pleural drainage in 50 cases, anterior mediastinotomy in 48 cases, pneumonectomy in 28 cases, open pleural biopsy in 24 cases, and thoracoplasty in 18 cases. In 12 patients (3.1%), two procedures were performed, and in one case, 3 procedures. In 65 cases (17%) there were complications, of which persistent air leakage after decortication & pulmonary resection was the most frequent (n=26). There was a mortality rate of 2.8% (11 cases). Conclusions: In our experience, surgery in the treatment of TB is indicated to resolve sequalae or complications, since cases of simple or multidrug-resistant TB can be managed pharmacologically. The morbidity and mortality rates in our series were acceptable.
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