LI Xiao 1 , WANG Ning 1 , BAO Lei 2 , WU Zhiqiang 3 , LI Gang 1 , CAI Cong 1 , SONG Yijie 1 , LI Dan 1 , WU Banggui 1 , JIANG Liangshuang 1 , YAO Xiaojun 1
  • 1. Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, Chengdu, 610061, P. R. China;
  • 2. Division of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu, 610061, P. R. China;
  • 3. Department of Thoracic Surgery, School of Clinical Medicine & The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, P. R. China;
YAO Xiaojun, Email: flyingyao@163.com
Total lung resection; destroyed lung; pulmonary tuberculosis; complications; clinical management; influencing factors
10.7507/1007-4848.202412095
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Objective  To evaluate the surgical efficacy of unilateral pneumonectomy for the treatment of tuberculous destroyed lung, analyze the causes of severe postoperative complications, and explore clinical management strategies. Methods  A retrospective analysis was conducted on the clinical data of patients with tuberculous destroyed lung who underwent unilateral pneumonectomy at the Public Health Clinical Center of Chengdu from 2017 to 2023. Postoperative severe complications were statistically analyzed. Patients were divided into a no-complication group and a severe-complication group, and the causes, management, and outcomes of complications were analyzed. Results  A total of 134 patients were included, comprising 69 males and 65 females, with a mean age of 17-73 (40.43±12.69) years. There were 93 patients undergoing left pneumonectomy and 41 patients undergoing right pneumonectomy. Preoperative sputum smear was positive in 35 patients, all of which converted to negative postoperatively. There were 58 patients with hemoptysis preoperatively, and none experienced hemoptysis postoperatively. Postoperative incisional infection occurred in 8 (5.97%) patients, and postoperative pulmonary infection, as assessed by clinical pulmonary infection score, occurred in 26 (19.40%) patients. Severe postoperative complications occurred in 17 (12.69%) patients, including empyema in 9 (6.72%) patients, bronchopleural fistula with empyema in 1 (0.75%) patient, severe pneumonia in 3 (2.24%) patients, postpneumonectomy syndrome in 1 (0.75%) patient, chylothorax in 1 (0.75%) patient, ketoacidosis in 1 (0.75%) patient, and heart failure with severe pneumonia in 1 (0.75%) patient. Perioperative mortality occurred in 2 (1.49%) patients, both of whom underwent right pneumonectomy. Multivariate logistic regression analysis revealed that a history of ipsilateral thoracic surgery, concomitant Aspergillus infection, and greater blood loss were independent risk factors for severe complications following unilateral pneumonectomy for tuberculous destroyed lung (P<0.05). Conclusion Unilateral pneumonectomy for patients with tuberculous destroyed lung can significantly improve the clinical cure rate, sputum conversion rate, and hemoptysis cessation rate. However, there is a certain risk of severe perioperative complications and mortality, requiring thorough perioperative management and appropriate management of postoperative complications.

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