[Surgical treatment of multidrug resistant pulmonary tuberculosis cases]

We report on the results of surgical treatment of pulmonary tuberculosis cases intractable to ordinary therapy due to acquired drug-resistance against multiple anti-tuberculosis drugs (MDR-Tbc).

From 1983 to 1994, 54 patients were administered surgical treatments (60 interventions in all) for pulmonary tuberculosis. Among them, 46 were MDR Tbc cases (52 interventions in all) and were enrolled for this study. The Japanese criteria for drug resistance were referred to, the threshold of resistance in each drug being as follows, INH 0.1, RFP 50, EB 2.5, SM 20, KM 100, TH 25, EVM 100, CPM 100, CS 40, PAS 1 microgram/ml. Bacteriological examinations of sputa were repeated in the postoperative period until upto several years, and the continued absence of Tbc. bacilli for more than 12 months was considered as cured.

(1) 37 patients underwent removal of lung mass including tuberculous foci mainly fibrous cavitary lesions (40 interventions in all). The procedures are as follows 22 upper lobectomies and/or partial resections of adjacent lobes. 1 middle lobectomy. A lower lobectomy, 14 pneumonectomies, 2 segmentectomies. In 3 cases, multiple operations were carried out on 2 occasions; 2 upper lobectomies followed by completion pneumonectomies. 1 right upper lobectomy followed by left S3 segmentectomy. Except 2 cases having died of pneumonia and suicide within 12 months after operation, we have 38 cases available for evaluation. Bacteriological relapses were confirmed in 7 among 38 cases postoperatively. 2 of these 7 relapsed cases underwent additional completion pneumonectomies and attained complete cure. Bacteriological relapse-rate was therefore 18.4% (7/38) and the ultimate cure rate of pulmonary MDR-Tbc was 88.6% (31/35). (2) 7 patients underwent thoracoplasties (not corrective, once for each patient). In 2 cases bacteriological relapse was confirmed. Other 5 cases remained bacteriologically silent over a long postoperative period. (3) 4 patients underwent cavernostomies, 3 of them got satisfactory result in reducing the bacterial presence in the sputum (preoperative abundant bacilli (Gaffky 7, 8) turned mean-negative within 2 months after cavernostomy).

With the above-mentioned results we conclude that surgical treatment is highly effective in intractable pulmonary MDR Tbc cases.