关键词: 分枝杆菌感染,非典型性, 肺, 外科手术, 治疗结果, 评价研究

Abstract:

Objective To investigate the role and efficacy of surgical treatment in patients with non-tuberculous mycobacterium (NTM) pulmonary disease. Methods Totally, 24 patients with NTM lung disease admitted to Guangzhou Chest Hospital from January 2009 to December 2017 were collected as subjects, including 9 males and 15 females, with the median age of 44.50 (30.75,55.00) years. The course of NTM pulmonary disease ranged from 0 to 6 years, with a median course of 1.0 (0.5,3.8) years. The medical records of the study subjects, including basic diseases, onset characteristics, clinical symptoms, mycobacterial culture and strain identification results, chest CT scan results, surgical conditions and treatment results, were retrospectively analyzed. Results Among the 24 patients, there were 11 (45.8%) cases with Mycobacterium avian-intracellular (MAC) pulmonary disease and 13 (54.2%) cases with Mycobacterium turtle-abscess pulmonary disease. The patients received preoperative chemotherapy for 3 to 18 months, among which, 1 patient (4.2%) experienced sputum negative conversion, and 23 patients (95.8%) experienced repeated positive sputum negative conversion. There were 13 cases (54.2%) of pulmonary lesions with recurrent progression and improvement or deterioration, 17 cases (70.8%) of pulmonary lesions with enlarged or unhealed cavities and accompanied by complex lesions, and 23 cases (95.8%) with the coexistence of cystic bronchiectasis in the tongue segment of the right middle lobe and the left upper lobe. The distribution of lesions that invaded the pulmonary lobe ranged from 1 to 6, with a median of 4.0 (3.3, 5.0) lesions. None of the patients died intraoperatively or postoperatively, including 1 case of total pneumonectomy (4.2%), 12 cases of single lobectomy (50.0%) and 11 cases of combined lobectomy (45.8%). Postoperative follow-up was conducted for 1 year, and 19 patients (79.2%) were cured and treated successfully, while treatment failed in 5 patients (20.8%) with lesion involvement in 5 or 6 lobes. The incidence of surgical complications was 33.3% (8/24), including 2 cases with residual granulation tissue hyperplasia and caseous necrosis, 5 cases with pleural hemorrhage and infection, and 1 case with poor wound healing. Among the 20 patients with excised lesions, 14 were positive for Mycobacterium culture and 6 were negative, while 11 cases experienced sputum negative conversion and 6 cases were cured after operation, with no significant difference (χ ²=0.30, P=0.585). MAC pulmonary disease and Mycobacterium turtle-abscess pulmonary disease were cured by surgery in 9 and 10 patients, respectively. Conclusion Surgery combined with chemotherapy can improve the rate of sputum negative conversion and treatment success rate for NTM pulmonary disease.

Key words: Mycobacterium infection,atypical, Lung, Surgery, Treatment outcome, Evaluation research