Shirinzadeh A, Montazeri V, Sokooti M.
Results of pulmonary resection for Multi Drug Resistant Tuberculosis.
Rawal Med J Jan ;32(2):156-9.

Objective: To report our experience of surgical intervention in Multi-Drug Resistant Tuberculosis (MDR-TB). Methods: During a 10 year period, fifty MDR-TB patients (26 men and 24 women) had surgical intervention and underwent 54 pulmonary resections. All had a minimum of 4 months of medical therapy before operation and at the end of this period, the sputum was positive. All had documented MDT-TB in-vitro studies in laboratories of Tabriz University of Medical Sciences. Results: Fifty patients underwent surgical operation. Four patients underwent eight pulmonary resections. Nineteen patients (6 women and 13 men) had positive sputum at the time of surgery. Pulmonary involvement was at left lung in 31 (62%) and at right lung in 19 (38%) patients. Thirty seven patients (74%) had been on 4 drug regimen and 13 (26%) on 2 drug regimen in the past. Hemoptysis, total pulmonary destruction, hydropneumothorax, bronchopleural fistula and positive sputum were the main causes of referral for surgery. Thirty patients underwent lobectomy, 12 segmentectomy and 8 pneumonectomy. Operative mortality was 4% (2 patients). Significant morbidity was 14% (7 patients). After the operation, the sputum remained positive in 3 (6%) patients. Mean length of follow-up was 3.5 years (4 to 80 months). Conclusions: Surgery remains an important adjunct to medical therapy for 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. (Rawal Med J 2007;32:156-159).

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