PURPOSE:The aim of the study is to evaluate the indications, surgical procedures and results for the patients with different clinical forms of thoracic tuberculosis, on the basis of the experience acquired on 427 cases operated in Surgical Clinic IV UMPh Targu-Mures, Romania, by a single surgical team.
METHODS:We analised 427 patients with thoracic tuberculosis who underwent surgery in Surgical Clinic 4 University of Medicine and Pharmacy from Targu-Mures, Romania, between 1985–2007 (23 years). 336 (78,69%) were male, 91 (21,31%) were women, age ranging from 14–82, average 44 years. The anatomic location of tb lesions were: pulmonary- 79 cases (18,50%), pleuro-pulmonary- 278 cases (65,11%), pleural- 31 cases (7,26%), thoracic wall- 11 cases (2,58%). Main indications for surgery were: pneumothorax- 126 cases, aspergilloma- 9 cases, pulmonary nodules- 33 cases, large pulmonary cavities- 42 cases, destroyed lung- 29 cases, massive hemopthysis- 23 cases, pleural empyema- 167 cases. Operations performed included: drainage- 143 cases, decortication- 93 cases, thoracopleuroplasty- 126 cases, pulmonary resections- 110 cases, other procedures (open thoracic window, Schede‘s operation, debridements, etc.)- 19 cases.
RESULTS:Postoperative outcome was uneventful in the majority of the cases. Postoperative complications were seen in 86 cases (20,14%). The mortality rate was 9,13% (39 cases).
CONCLUSION:This series is the largest personal series in Romania in the last 25 years and it proves that in the same time with the rising of difficult and complicated forms of thoracic tuberculosis operations like thoracoplasty, Elloeser‘s operation, Schede‘s operation became in fashion again, having good results in time. Some operations in TB surgery are technically challenging and difficult due to the altered biological status of these patients, who are usually very fragile and cannot stand more radical and extensive procedures.
CLINICAL IMPLICATIONS:Because of the ageing and chronicisation of the lesions, mixed pleuropulmonary forms of tuberculosis became more frequent with an increased number of thoracopleuroplasties associated with or without pulmonary resections.
DISCLOSURE:Alexandru Botianu, None.