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The Annals of Thoracic Surgery, Vol 52, 1108-1111, Copyright © 1991 by The Society of Thoracic Surgeons
M Pomerantz, L Madsen, M Goble and M Iseman
Between August 1983 and October 1990, 42 patients with resistant
Mycobacterium tuberculosis underwent 44 pulmonary resections. During the
same time, 38 patients with mycobacterial infections other than
tuberculosis had 41 pulmonary resections. All patients either were poor
candidates for medical therapy alone or had existing complications
requiring surgical intervention. There was one operative death in each
group, both from adult respiratory distress syndrome (postpneumonectomy
pulmonary edema). Complications were high, with bronchopleural fistula most
commonly occurring after right pneumonectomy in patients infected with
Mycobacterium avium with superimposed infection with nonmycobacterial
pathogens. In patients undergoing pneumonectomy for resistant Mycobacterium
tuberculosis, the left lung was most often resected. It is recommended that
if localized disease is present and medical treatment is likely to fail,
pulmonary resection should be performed for resistant Mycobacterium
tuberculosis infection after 3 months of drug-specific therapy. Muscle
flaps were used frequently to avoid residual space and bronchial stump
problems. Earlier resection in patients with indolent nontuberculous
mycobacterial pulmonary infections is advocated before extensive
polymicrobial contamination and right lung destruction.
ARTICLES
Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections
Department of Surgery, Porter Memorial Hospital, Denver, Colorado.
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