SURGERY FOR PULMONARY TUBERCULOSIS

During the period 1990-1994 a total of 578 operations were performed i n 502 patients with various forms of tuberculosis. Most of the patient s (68%) were men aged 20 to 50 years (70%). Sputum cultures were posit ive in 55% of the patients. More than half of all patients were chroni c smokers, and about 10% were alcoholics or drug addicts. There were n o human immunodeficiency virus-infected patients, and none with acquir ed immunodeficiency syndrome. The most frequent surgical interventions were, according to the classification adopted in Russia, for cavernou s or fibrocavernous tuberculosis (196 cases) and tuberculomas (161 cas es). The main operative procedures used were pulmonary resection (n = 280) and pneumonectomy or pleuropneumonectomy (n = 80). Diseased intra thoracic lymph nodes were ablated in 62 patients. Thoracoplasty or tho racomyoplasty were performed in 46 cases, thoracostomy in 37, closure of a thoracic wall defect in 27, and reamputation of the main bronchia l stump in 6. Postoperative complications arose in 20% of the patients . More than half occurred in the pleural cavity or bronchi and were as sociated with tuberculous infection. The postoperative hospital case-f atality rate was 2%. The overall clinical efficacy by the time of disc harge was 82.7% (95% in tuberculomas). Reactivation of tuberculosis ov er the first 3 years after discharge occurred in 6.6% of the patients. Most patients with large or multiple caverns, tuberculomas, intrathor acic caseous lymphadenitis, or various complications of pulmonary tube rculosis cannot be cured (or are not amenable to cure in principle) by means of antibacterial therapy because of irreversible morphologic ch anges in the lungs, bronchi, pleura, lymph nodes, or thoracic wall. Fo r this reason, indications for surgical management of pulmonary tuberc ulosis should be generally expanded. Excessively long antibacterial th erapy for tuberculosis is often inadvisable. Although the availability of standardized regimens of antibacterial therapy is strategically es sential, each patient must be treated according to an individual plan. In certain cases thoracic surgeons should be enlisted to participate in the development of such plans.