Surgical treatment of pulmonary tuberculosis has been carried out in China for nearly 70 years, which is mainly summarized as two types of atrophy therapy and resection therapy to stop bacillary excretion and cavity closure; with the progress of tuberculosis treatment, surgical treatment of tuberculosis tends to be cautious; the indications for tuberculosis surgery have changed dramatically with the improvement and innovation of surgical methods and modernization of medical equipment.
1, cavitary tuberculosis: cavitary tuberculosis is an important source of infection of tuberculosis.
Indications for surgery
Patients with cavitary tuberculosis who have been treated for 18 months with standardized anti-tuberculosis treatment in internal medicine, but no significant change or thickening or enlargement of the cavity and persistent positive sputum tuberculosis, especially those who are resistant to various anti-tuberculosis drugs.
2, cavitary tuberculosis, especially thick-walled cavities, combined with recurrent hemoptysis or secondary infection, with obvious clinical symptoms and ineffective drug treatment. Or huge cavity with tension cavity and diameter greater than 3cm caused by poor drainage due to bronchial lesion.
3.Those who cannot exclude cancerous cavities.
2.Tuberculosis ball and large cheese foci: The pathological changes are mainly encapsulated cheese-like necrotic tissue or tuberculous granulation tissue. Effective drugs cannot reach the lesion or only a little drug penetration into the lesion, and cannot achieve the treatment purpose, and have different degrees of drug resistance to different drugs.
Indications for surgery
1.Tuberculosis tumor standardized anti-tuberculosis treatment for more than 12 months, sputum positive, combined with hemoptysis.
2.Tuberculosis cannot be ruled out as a malignant lesion.
3.Tuberculosis tumor diameter greater than 3cm, after standard anti-tuberculosis treatment is ineffective, or standard anti-tuberculosis treatment during the tuberculosis tumor short-term increase, can be used as a relative indication for surgery.
3, hemoptysis: hemoptysis is clinically referred to as hemoptysis with a hemoptysis volume of more than 300ml or a hemoptysis volume of more than 600ml in 24h. Tuberculosis is the most common cause of hemoptysis. The application of techniques such as bronchial artery embolization has resulted in satisfactory outcomes for many patients with hemoptysis. However, the primary cause of hemoptysis remains, and many patients experience a recurrence of hemoptysis after bronchial artery embolization, so subsequent radical surgical treatment is still necessary.
Indications for surgery
1.A single hemoptysis of more than 300ml, or 24h hemoptysis of more than 600ml, where conservative medical treatment is ineffective.
2.Recurrent hemoptysis, who have had asphyxia, aura of asphyxia or hypotension or shock.
3.The site of bleeding is clear.
4.Cardiopulmonary function and general condition can tolerate the surgery.
4, one lobe or one side of the destroyed lung: there are often extensive fibrous caseous lesions in the lung, and mostly accompanied by bronchial dilatation and scattered multiple small cavities, such a lung has basically lost respiratory function, and more sputum, hemoptysis.
Indications for surgery
1, Initial treatment or irregular treatment for more than six months, positive sputum bacteria or obvious clinical symptoms.
2.No obvious active tuberculosis lesion in the contralateral lung, lung function and general condition permitting, lobectomy or whole lung resection on one side should be performed according to the extent of lesion.
5, mediastinal lymph node tuberculosis: Once the diagnosis of mediastinal lymph node tuberculosis is confirmed, effective anti-tuberculosis treatment should be taken first.
Indications for surgery
1, compression or invasion of adjacent organs and organs and cause corresponding adverse reactions and symptoms, after regular anti-tuberculosis treatment, the lesion is not absorbed and continues to expand.
2.The lesion cannot be differentiated from other mediastinal lymph node disorders and no clear diagnosis can be made.
3.The lesion lymph nodes are larger than 3CM in diameter and have formed tuberculous abscess.
4.Patients with pulmonary atelectasis and caseous pneumonia, which are not treated by internal medicine.
6.Tuberculous bronchiectasis: It is a common complication of pulmonary tuberculosis, and its occurrence site is mostly consistent with the site of tuberculosis lesion. It is mostly columnar and cystic dilatation.
Indications for surgery
1, tuberculous bronchiectasis lesion is limited to one lobe or one whole lung.
2.Recurrent hemoptysis with obvious symptoms and ineffective anti-tuberculosis treatment by standard internal medicine.
3, Cardiopulmonary function and general condition can tolerate surgery.
4.When tuberculous bronchiectasis lesions exist in both lobes of the lungs, the indications for surgery should be strictly controlled.
7, multidrug-resistant tuberculosis: internal chemotherapy is ineffective, and drug-resistant patients themselves become infectious sources of drug-resistant bacteria that infect people and form primary drug-resistant patients. We believe that surgical treatment of multidrug-resistant tuberculosis should tend to be aggressive.
Indications for surgery
1.Multidrug-resistant limited pulmonary tuberculosis with more than 18 months of regular chemotherapy and positive sputum.
2.Multidrug-resistant tuberculosis with chronic fibrous cavity, abscess chest, bronchopleural fistula or one destroyed lung without active lesions in the contralateral lung.
3.Multidrug-resistant tuberculosis with uncontrollable hemoptysis and recurrent pulmonary infections.
4, cardiopulmonary function and general condition can tolerate surgery
8.Pulmonary tuberculosis combined with pneumothorax.
Indications for surgery
1.Pneumothorax with multiple episodes (more than 2~3 times); closed drainage of chest cavity for more than 1 week, but still continue to leak air.
2.Liquid pneumothorax with early signs of infection.
3, hemopneumothorax who has not reopened the lung after closed drainage of the chest or who continues to bleed.
4.Pneumothorax side combined with obvious pulmonary maculopathy
5 a case of pneumothorax, and the contralateral side has a history of pneumothorax should be operated early.
6, pulmonary tuberculosis combined with pneumothorax: early drainage should be early, and when the effect is not obvious, open-chest negotiation or pleural fiber plate stripping should be performed.
7, other surgical indications: ① long-standing chronic fibrous caseous tuberculosis, recurrent attacks, lesions are more concentrated in a lobe; ② still have exclusion of bacteria after thoracoplasty, if the conditions can be considered resection treatment; ③ the diagnosis of uncertain lung suspicious lumpy shadow or unexplained pulmonary atelectasis.
9.Surgical treatment of extrapulmonary tuberculosis: there are more types of extrapulmonary tuberculosis, and on the basis of standardized chemotherapy, corresponding surgical treatment is taken according to different situations.