SURGICAL ASPECTS OF MYCOBACTERIOSIS - THE LAST 20 YEARS

Introduction: Tuberculosis remains one of the major infectious disease s. Its incidence has grown in immigrants and in immunosuppressed patie nts, and, moreover, cases of drug resistance are on the increase. The goal of this study was to analyze the implications of these new develo pments and surgical experience in our patients. Method: The cases of 1 04 patients with tuberculosis hospitalized between 1975 and 1995 were reviewed retrospectively. Results: 22% of the patients (23/104) were i mmigrants. No HIV-positive patients were described but association wit h debilitating diseases was frequent. Diagnosis was chiefly by histolo gy. The culture was positive in only 30/104 patients (29%). Drug resis tance was seen in only one patient (1%). 72/104 patients (69.2%) prese nted with an infection of the pulmonary parenchyma, 21/104 (20.2%) wit h pleural tuberculosis including tuberculous empyema, 3/104 (2.9%) wit h tuberculosis of the chest wall and 8/104 (7.7%) with mediastinal tub erculosis. Surgery was performed in 84/104 patients (80.8%). The chief indications were suspected carcinoma in 39/84 cases (46.4%), destroye d lung in 11/84 (13.1%), empyema combined with bronchopleural fistula in 10/84 (11.9%), enlarged mediastinal lymphnodes of unknown dignity i n 7/84 (8.3%), recurrent pleural effusion in 5/84 (5.9%) and bronchial stenosis in 4/84 (4.8%). Conclusion: The number of surgical patients with tuberculosis has remained fairly stable over the last 20 years, b ut the proportion of immigrants has grown since 1990. Thoracoscopy is playing an increasingly important role in the diagnosis and surgical t reatment of tuberculosis (recurrent pleural effusion, resection of per ipheral pulmonary nodules turning out to be tuberculoma).