TREATMENT OF BRONCHIAL STRICTURE DUE TO ENDOBRONCHIAL TUBERCULOSIS

Between 1974 and 1995 we encountered 19 cases of bronchial stricture o r obliteration caused by endobronchial tuberculous lesions. In 11 the involvements were located at the right bronchus (including involvement s of segmental and middle lobe bronchi) and in 8 at the left bronchus. On bronchoscopic biopsy of the stenosed bronchus, 7 patients showed h istopathologic findings of tuberculous bronchitis, but 12 patients sho wed nonspecific inflammatory granular tissue. Five patients were kept under conservative observation because of mild subjective symptoms or refusal to undergo operation. Two patients underwent stent procedures but had poor outcomes. Twelve patients underwent operation. As the bro nchial lesions in four of them were confined to the lobar or segmental bronchus, lobectomy was performed. One patient with a history of infa ntile tuberculosis had developed complete obliteration of the left mai n bronchus and cystic bronchiectasis in the entire lung parenchyma; pn eumonectomy was essential. Seven patients who had strictures involving the main bronchus underwent bronchoplastic surgery with right (n = 4) or left (n = 3) upper sleeve lobectomy. None of the patients treated surgically showed any postoperative complication or recurrence of the tuberculosis. These surgical results for endobronchial tuberculosis in dicate the need for early detection and operation. Bronchoscopy and co mputed tomography are the methods of choice for accurate diagnosis of bronchial involvement and assessment of the surgical indications. It i s emphasized that bronchoplastic surgery is the best treatment for bro nchial stricture involving bilateral main bronchi.