[Modern surgical treatment of pulmonary tuberculosis]

Correctly performed antituberculous chemotherapy, together with the early diagnostics of tuberculosis, significantly lowered the need for surgery. Surgery is limited to patients with poor or no response to chemotherapy. In the period between 1983-1992 212 tuberculous patients were operated in the Clinic for Thoracic surgery, the Institute for the Pulmonary Disease the operated patients had the following form of the disease: primary tuberculosis in 4 patients (1.87%), 104 patients (49.06%) had the postprimary form of the disease, 67 patients (31.60%) had tuberculoma (causative lesion) cavernous tuberculosis existed in 33 patients (15.57%), while only 4 patients (1.87%) had diffuse pulmonary lesion. Diagnosis of post-tuberculous syndrome was made in 68 patients (32.08%). Secondary aspergylloma existed in 36 patients while the frequency of bronchial stenosis and bronchiectasis was the same -m 31 patients (16.98% and 14.63% respectively). One patient had broncho-oesophageal fistula. Tuberculous empiema, complicating the disease, existed in 36 patients (16.98%). Comparing the two 5-years periods, (1983-87 and 1988 to 1992) the authors conclude that the number of operations for tuberculosis is decreasing. Treatment was successful in all patients except in a patient with a broncho-esophageal fistula, who died postoperatively slow lung reexpansion existed in 5 patients, and in two cases partial upper thoracoplasty had to be done in order to solve the complication of the initial treatment. In all cases postoperative antituberculous chemotherapy was performed taking in consideration the problem of possible drug-resistance. There were no recurrences.