[Surgical treatment of multi-drug resistant pulmonary tuberculosis in 188 cases]

Multi-drug resistant pulmonary tuberculosis (MDR-PTB) is a major cause of morbidity and mortality throughout the world currently. Optimal therapy for patients infected with MDR-PTB often requires surgical intervention to eradicate the infection.

During a 15-year period from 1990 to 2005, of the 906 cases receiving surgical treatment for pulmonary tuberculosis in Shanghai Pulmonary Disease Hospital, 188 patients with MDR-PTB underwent 200 surgical procedures. All the patients of MDR-PTB had received individualized multiple-drug chemotherapy at least 2 - 3 months before surgery, as determined by drug susceptibility studies. Of the surgical procedures, 85 lobectomies, 48 pneumonectomies and other complicated surgical techniques were performed respectively. Twelve patients underwent repeated operation. Muscle flaps and omentum in some cases were used to avoid residual space and bronchial stump problems.

Operative mortality was 0.5% (1/200). Postoperative mortality was 3.2% (6/187). Significant morbidity was 13.9% (26/187). All of the patients had positive sputum at the time of surgery. After the operation, the sputum remained positive in only 2 patients. Mean length of follow-up was 6.7 years (range 3 - 180 months). All of the patients after surgery continued their individualized multiple-drug chemotherapy for 3 - 18 months.

Surgery remains an important adjunct to medical therapy for the treatment of MDR-PTB. Surgical treatment should be considered for localized diseases, persistent sputum positivity, or intolerance of medical therapy.