In the era of modern chemotherapy, surgery for tuberculosis has become the second-line treatment, especially for patients with primary tuberculosis, and its cure rate has been greatly improved; however, because of the primary or secondary resistance of tuberculosis bacilli to anti-tuberculosis drugs, which is easy to produce, leading to an increase in recurrent refractory tuberculosis, and some of them even develop into severe tuberculosis, which not only fails medical treatment but also loses the opportunity of surgical treatment. is worth discussing. Since the introduction of rifampicin in the 1970s, the cure rate of tuberculosis patients who have completed a course of standardized therapy under strict management can reach more than 90%, and the relapse rate does not exceed 5% after 5 years of drug withdrawal. However, in China, only 25.7% of patients with tuberculosis are registered, and only 17.7% of them can be managed with chemotherapy, with a recurrence rate of 34.8%. Reasonable treatment or delayed treatment, so that the opportunity for initial treatment is lost, and the patients are referred to retreatment or refractory or even become seriously ill, resulting in a significant increase in drug-resistant TB patients, which also becomes one of the main reasons for the occurrence of resistance of the tuberculosis bacteria to anti-tuberculosis drugs, and the increase in the rate of drug resistance is significantly related to the previous anti-tuberculosis treatment. The incidence of drug resistance was 7%, 19% at 2-14 months and 39% at 14 months. In addition, drug-resistant cases themselves become a source of transmission of drug-resistant bacteria, allowing primary drug resistance to develop in some patients who are infected. Thus delaying ineffective medical treatment risks resistance to more drugs, while possibly allowing the lesion to spread contralaterally and losing the opportunity for surgical treatment. Therefore, rational chemotherapy and surgery are the two most important factors for the cure of drug-resistant tuberculosis. 2. Indications for surgery and timing of surgery for drug-resistant tuberculosis In the course of tuberculosis treatment, it is generally believed that surgical treatment should be considered in a timely manner once medical retreatment is found to fail to achieve sputum conversion and cavity closure. However, there is no unified international standard for the timing of surgical treatment of drug-resistant TB patients; although reports vary, there is a positive attitude toward surgical treatment of drug-resistant TB, especially for patients limited to a certain segment or lobe, or even a certain side. In our group of 36 patients with drug-resistant tuberculosis, 15 were left-sided, 16 were right-sided, 5 were bilateral, and 26 were lobectomized, suggesting that the majority of surgical patients were unilateral, which is consistent with the literature. We believe that the selection of sensitive drugs for drug-resistant pulmonary tuberculosis should be the center of the preoperative and postoperative period, and according to the principle of combined pulmonary tuberculosis drugs, no less than two sensitive drugs should be used preoperatively and postoperatively for 6-12 months. The selection of sensitive drugs is based on preoperative drug sensitivity results, but we believe that the main thing is to select patients based on their previous drug history; observations in this group also show that patients resistant to 2-3 drugs have more chances of surgery and fewer postoperative complications, while patients resistant to multiple drugs have more postoperative complications. Also sensitive drugs have an important impact on surgical outcome. The literature shows that surgical complications are significantly higher in cases that have failed long-term or irregular chemotherapy due to lack of postoperative protection from sensitive drugs. The surgical complications were less than 2% in patients with a drug history of less than one year and about 7% in patients with a drug history of more than ten years. The recent complications in our group were higher at 13%, which may be related to the surgical operation. The issue of recurrence rate may be related to patient selection. There was no case of recurrence in our group and Nakajima reported a high recurrence rate of 18% (3/38). We believe that the indications for surgery for drug-resistant tuberculosis should take into account the issue of sensitive drugs in addition to having the indications for surgery for pulmonary tuberculosis in general. However, any approach to expand the scope of surgical treatment of pulmonary tuberculosis and rudimentary surgery is not desirable, but delayed surgery can lead to a lost chance of cure. The authors have encountered a case of unilateral destruction of the lung in which the lesion spread to the opposite side due to missed surgical opportunity, which is a profound lesson. 3, the choice of surgical modality Whether medical treatment or surgical treatment, the purpose should be to stop the exclusion of bacteria, cavity closure. In this group, 26 cases of lobectomy and 10 cases of total pneumonectomy were performed, 4 cases of severe tuberculosis were performed, 1 case each died after surgery due to cardiac arrest and acute respiratory failure, 1 case of bronchial stump fistula and 1 case of contralateral spread of lesion; 1 case of bronchial stump fistula appeared in lobectomy, which was closed by medical treatment and additional chest modification, suggesting that the complications of total pneumonectomy are still higher than those of lobectomy. In this group, there were 7 cases of additional modified chest reconstruction without complications, and although the patients had some degree of deformity and reduced lung function after surgery, the tuberculosis lesions were eliminated. Especially for drug-resistant tuberculosis, it is still valuable to take limited thoracic reformation when appropriate and timely. In conclusion, surgery still has positive significance in eliminating the source of infection and reducing complications. In the surgical treatment of patients with long-term bacteriophage excretion, timely pneumonectomy or thoracic reformation is an effective means of treating such patients, provided that the case is well selected.