Tuberculosis was a scourge of early humans, as shown by its discovery in the lungs of Egyptian mummies. Nowadays mycobacterium tuberculosis(MTB) continues to be a major cause of morbidity and mortality throughout the world.The world health organization(WHO) declare MTB a global emergency.During MTB Therapy has been emergence of multi-drug resistant MTB(MDR-TB). MDR-TB is a strain of mycobacterium tuberculosis that is resistant to current anti-tuberculosis agent.Multi-drug resistant MTB often requires surgical intervention.
During 10 years period 50 patients (26 men and 24 women)Had surgical intervention that underwent pulmonary resections. All patients had a minimum of 4 month of medical therapy before operation.All patients had multi-drug resistant mycobacterium tuberculosis that were hospitalized at the thoracic surgery ward and underwent surgical operation.
50 patients underwent surgical operation. 19 patients (6 women,13 men) had positive sputum at the time of surgery. Left pulmonary involvement were 31 cases(62%) and right lung 19 cases(38%). 37 patients (74%) had been taken 4 drug regimen and 13 patients(26%) 2 drug regimen in the past. Emergence of MTB strains resistant to the primary antibiotics has largely been due to physicians and patient complacency (irregular taking of drugs and early discontinuing).Hemoptysis, total pulmonary destruction, hydropneumothorax, bronchopleural fistula and positive sputum were the main causes of surgery. 30 patients underwent lobectomy, 12 patients segmentectomy and 8 patients pneumonectomy. Operative mortality was 4% (2 patients) ,significant morbidity was 14% (7 patients).After the operation, the sputum remained positive in 3 patients(6%). Mean length of follow-up was 3.5 years (4 to 80 months).
Surgery remains as an important adjunct to medical therapy for patients with multi-drug resistant mycobacterium tuberculosis (MDR-MTB). In the setting of localized diseases, persistent cavitary disease, lung or lobar destructions or patient intolerance to medical therapy, surgical resection of the lung should be undertaken. The surgical complications and post surgical mortality and morbidity are acceptable. Postponing the surgical operation will worsen the results.
Timing of the operation and malnutrition are major problems to be considered.
Abulfazal Shirin Zadeh, None.