Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DING Chao , LIU Yugang , WEI Lin , GU Zhenning ,  ZHU Changsheng

Department of Thoracic Surgery, Xi’an Chest Hospital, Xi’an, 710100, P.R.China;

Corresponding author：

ZHU Changsheng, Email: zhuchangshengdr@hotmail.com

Keywords：

Video-assisted thoracoscopic surgery; tuberculosis; surgery

DOI：

10.7507/1007-4848.201809038

Video：

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Objective To investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.Methods We retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two^[1], groups.Conclusion Compared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.

Citation： DING Chao, LIU Yugang, WEI Lin, GU Zhenning, ZHU Changsheng. Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 653-659. doi: 10.7507/1007-4848.201809038 Copy

1.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
2.	Yen YT, Wu MH, Lai WW, et al. The role of video-assisted thoracoscopic surgery in therapeutic lung resection for pulmonary tuberculosis. Ann Thorac Surg, 2013, 95(1): 257-263.
3.	Tseng YL, Chang JM, Liu YS, et al. The role of video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis. Medicine(Baltimore), 2016, 95(18): e3511.
4.	车勇, 常炜, 刘志刚, 等. 电视胸腔镜治疗肺结核临床疗效分析. 新疆医学, 2017, 47(6): 585-588.
5.	唐神结, 高文. 临床结核病学. 人民卫生出版社, 2011. 356.
6.	WHO. Guidelines for the programmatic management of drug-resistant tuberculosis, 2011 Update. WHO/HTM/TB/ 20116. 2011. Geneva: World Health Organization; 2011.
7.	赵丰曾. 肺结核外科适应症 (草案). 中国防痨杂志, 1985, 7(4).
8.	肺结核手术适应证标准 (试行方案). 肺结核手术适应证标准 (试行方案). 中华结核和呼吸杂志, 1994, 17(2): 73.
9.	Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: A report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
10.	Odell JA. The history of surgery for pulmonary tuberculosis. Thorac Surg Clin, 2012, 22(3): 257-269.
11.	严碧涯. 肺结核治疗的进展. 中国防痨杂志, 1981, 3, (2): 1-8.
12.	刘鸿翘. 肺结核外科疗法国内研究近况. 中国防痨杂志, 1988, 10(1): 44-45.
13.	金锋. 坚定不移地推进肺结核手术适应证的修订——热烈祝贺"首届结核外科建设与手术适应证研讨会"胜利召开. 中国防痨杂志, 2017, 39(9): 916-925.
14.	Kempker RR, Rabin AS, Nikolaishvili K, et al. Additional drug resistance in mycobacterium tuberculosis isolates from resected cavities among patients with multidrug-resistant or extensively drug-resistant pulmonary tuberculosis. Clin Infect Dis, 2012, 54(6): e51.
15.	Dartois V, Barry CE. Clinical pharmacology and lesion penetrating properties of second- and third-line antituberculous agents used in the management of multidrug-resistant (MDR) and extensively-drug resistant (XDR) tuberculosis. Curr Clin Pharmacol, 2010, 5(2): 96-114.
16.	Park SK, Kim JH, Kang H, et al. Pulmonary resection combined with isoniazid- and rifampin-based drug therapy for patients with multidrug-resistant and extensively drug-resistant tuberculosis. Int J Infect Dis, 2009, 13(2): 170-175.
17.	Vashakidze S, Gogishvili S, Nikolaishvili K, et al. Favorable outcomes for multi- and extensively drug resistant tuberculosis patients undergoing surgery. Ann Thorac Surg, 2013, 95(6): 1892.
18.	Sihoe AD. The current role of thoracic surgery in tuberculosis management. Respirology, 2009, 14(7): 954-968.
19.	Takeda S, Maeda H, Hayakawa M, et al. Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg, 2005, 79(3): 959-963.
20.	Falzon D, Schünemann HJ, Harausz E, et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J, 2017, 49(3): 1602308.
21.	刘伦旭. 开胸手术将逐渐" 升级”为胸腔镜微创手术的补充. 中国胸心血管外科临床杂志, 2012, 19(2): 109-112.
22.	周逸鸣, 张雷, 宋楠, 等. 电视胸腔镜肺切除术治疗肺结核 815 例分析. 中国防痨杂志, 2017, 39(5): 448-451.
23.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
24.	Vadim G, Pischik. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis, 2014, 6(Suppl 6): S623-S630.
25.	Pezzella AT, Fang W. Surgical aspects of thoracic tuberculosis: a contemporary review--part 1. Curr Probl Surg, 2008, 45(10): 675.
26.	唐神结, 高文, 主编. 临床结核病学. 人民卫生出版社, 2011. 260.
27.	Pomerantz M, Madsen L, Goble M, et al. Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections. Ann Thorac Surg, 1991, 52(5): 1108.
28.	Fadel E, Missenard G, Chapelier A, et al. En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina. J Thorac Cardiovasc Surg, 2002, 123(4): 676-685.
29.	胡汶斌, 袁顺达, 俞幼林, 等. 胸腔镜辅助小切口与传统开胸手术治疗结核性毁损肺效果比较. 中华结核和呼吸杂志, 2016, 39(2): 143-144.
30.	王成, 张运曾, 金锋. 胸腔镜辅助小切口在结核性毁损肺叶切除术中的应用. 中国防痨杂志, 2017, 39(5): 445-447.
31.	Kempker RR, Vashakidze S, Solomonia N, et al. Surgical treatment of drug-resistant tuberculosis. Lancet Infect Dis, 2012, 12(2): 157-166.
32.	Shiraishi Y, Katsuragi N, Kita H, et al. Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg, 2009, 138(5): 1180.
33.	Mohsen T, Zeid AA, Hajyahia S. Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institution's experience. J Thorac Cardiovasc Surg, 2007, 134(1): 194-198.
34.	Wang H, Lin H, Jiang G, et al. Pulmonary resection in the treatment of multidrug-resistant tuberculosis: a retrospective study of 56 patients. Ann Thorac Surg, 2008, 86(5): 1640-1645.
35.	Kang MW, Kim HK, Choi YS, et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg, 2010, 89(5): 1597-1602.

1. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139(2): 366-378.
2. Yen YT, Wu MH, Lai WW, et al. The role of video-assisted thoracoscopic surgery in therapeutic lung resection for pulmonary tuberculosis. Ann Thorac Surg, 2013, 95(1): 257-263.
3. Tseng YL, Chang JM, Liu YS, et al. The role of video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis. Medicine(Baltimore), 2016, 95(18): e3511.
4. 车勇, 常炜, 刘志刚, 等. 电视胸腔镜治疗肺结核临床疗效分析. 新疆医学, 2017, 47(6): 585-588.
5. 唐神结, 高文. 临床结核病学. 人民卫生出版社, 2011. 356.
6. WHO. Guidelines for the programmatic management of drug-resistant tuberculosis, 2011 Update. WHO/HTM/TB/ 20116. 2011. Geneva: World Health Organization; 2011.
7. 赵丰曾. 肺结核外科适应症 (草案). 中国防痨杂志, 1985, 7(4).
8. 肺结核手术适应证标准 (试行方案). 肺结核手术适应证标准 (试行方案). 中华结核和呼吸杂志, 1994, 17(2): 73.
9. Jacobs JP, Mavroudis C, Jacobs ML, et al. What is operative mortality? Defining death in a surgical registry database: A report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg, 2006, 81(5): 1937-1941.
10. Odell JA. The history of surgery for pulmonary tuberculosis. Thorac Surg Clin, 2012, 22(3): 257-269.
11. 严碧涯. 肺结核治疗的进展. 中国防痨杂志, 1981, 3, (2): 1-8.
12. 刘鸿翘. 肺结核外科疗法国内研究近况. 中国防痨杂志, 1988, 10(1): 44-45.
13. 金锋. 坚定不移地推进肺结核手术适应证的修订——热烈祝贺"首届结核外科建设与手术适应证研讨会"胜利召开. 中国防痨杂志, 2017, 39(9): 916-925.
14. Kempker RR, Rabin AS, Nikolaishvili K, et al. Additional drug resistance in mycobacterium tuberculosis isolates from resected cavities among patients with multidrug-resistant or extensively drug-resistant pulmonary tuberculosis. Clin Infect Dis, 2012, 54(6): e51.
15. Dartois V, Barry CE. Clinical pharmacology and lesion penetrating properties of second- and third-line antituberculous agents used in the management of multidrug-resistant (MDR) and extensively-drug resistant (XDR) tuberculosis. Curr Clin Pharmacol, 2010, 5(2): 96-114.
16. Park SK, Kim JH, Kang H, et al. Pulmonary resection combined with isoniazid- and rifampin-based drug therapy for patients with multidrug-resistant and extensively drug-resistant tuberculosis. Int J Infect Dis, 2009, 13(2): 170-175.
17. Vashakidze S, Gogishvili S, Nikolaishvili K, et al. Favorable outcomes for multi- and extensively drug resistant tuberculosis patients undergoing surgery. Ann Thorac Surg, 2013, 95(6): 1892.
18. Sihoe AD. The current role of thoracic surgery in tuberculosis management. Respirology, 2009, 14(7): 954-968.
19. Takeda S, Maeda H, Hayakawa M, et al. Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg, 2005, 79(3): 959-963.
20. Falzon D, Schünemann HJ, Harausz E, et al. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J, 2017, 49(3): 1602308.
21. 刘伦旭. 开胸手术将逐渐" 升级”为胸腔镜微创手术的补充. 中国胸心血管外科临床杂志, 2012, 19(2): 109-112.
22. 周逸鸣, 张雷, 宋楠, 等. 电视胸腔镜肺切除术治疗肺结核 815 例分析. 中国防痨杂志, 2017, 39(5): 448-451.
23. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
24. Vadim G, Pischik. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis, 2014, 6(Suppl 6): S623-S630.
25. Pezzella AT, Fang W. Surgical aspects of thoracic tuberculosis: a contemporary review--part 1. Curr Probl Surg, 2008, 45(10): 675.
26. 唐神结, 高文, 主编. 临床结核病学. 人民卫生出版社, 2011. 260.
27. Pomerantz M, Madsen L, Goble M, et al. Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections. Ann Thorac Surg, 1991, 52(5): 1108.
28. Fadel E, Missenard G, Chapelier A, et al. En bloc resection of non-small cell lung cancer invading the thoracic inlet and intervertebral foramina. J Thorac Cardiovasc Surg, 2002, 123(4): 676-685.
29. 胡汶斌, 袁顺达, 俞幼林, 等. 胸腔镜辅助小切口与传统开胸手术治疗结核性毁损肺效果比较. 中华结核和呼吸杂志, 2016, 39(2): 143-144.
30. 王成, 张运曾, 金锋. 胸腔镜辅助小切口在结核性毁损肺叶切除术中的应用. 中国防痨杂志, 2017, 39(5): 445-447.
31. Kempker RR, Vashakidze S, Solomonia N, et al. Surgical treatment of drug-resistant tuberculosis. Lancet Infect Dis, 2012, 12(2): 157-166.
32. Shiraishi Y, Katsuragi N, Kita H, et al. Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg, 2009, 138(5): 1180.
33. Mohsen T, Zeid AA, Hajyahia S. Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institution's experience. J Thorac Cardiovasc Surg, 2007, 134(1): 194-198.
34. Wang H, Lin H, Jiang G, et al. Pulmonary resection in the treatment of multidrug-resistant tuberculosis: a retrospective study of 56 patients. Ann Thorac Surg, 2008, 86(5): 1640-1645.
35. Kang MW, Kim HK, Choi YS, et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg, 2010, 89(5): 1597-1602.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Video-assisted thoracoscopic lung resection in tuberculosis treatment: A retrospective cohort study

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