Download PDF
Zentralbl Chir 2017; 142(S 01): S53-S65
DOI: 10.1055/s-0043-109257
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Interdisziplinäre Therapie der Lungentuberkulose

Interdisciplinary Treatment of Patients with Pulmonary Tuberculosis
Joachim Pfannschmidt
,
Nicolas Schönfeld
Further Information

Publication History

Publication Date:
04 October 2017 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Die chirurgische Therapie der Lungentuberkulose war seit der breiten Verfügbarkeit effektiver Antibiotika nur noch in seltenen Fällen indiziert. Die zunehmende Problematik multiresistenter Tuberkulosestämme in den letzten 2 Jahrzehnten hat die Bedeutung chirurgischer Therapieverfahren jedoch erneut in den Fokus gerückt. Ziel dieser Arbeit ist die Darstellung der wesentlichen Indikationskriterien zur chirurgischen Behandlung im interdisziplinären Konzept mit den heutigen Möglichkeiten der tuberkulostatischen Therapie.

Abstract

Today surgical procedures for pulmonary tuberculosis are highly selective but owing to the increasing incidence of multidrug resistant tuberculosis has been becoming more and more relevant. Besides the treatment of tuberculosis foci in multidrug resistance tuberculosis to eliminate the source of relapse, complications as sequelae of tuberculosis are among the most frequent indications for surgery. In patients with cavernous lesions, destroyed lobe or lung, bronchiectasis, pleural empyema or hemoptysis thoracic surgical procedures may be warranted. However, in solitary pulmonary nodules operations with diagnostic purpose are necessary, not only to rule out a potential malignancy, but also to identify a so far unidentified tuberculoma. Considering the heterogenous group of patients with tuberculosis, surgical morbidity and mortality are in the known range for surgical resections in lung cancer patients.

Kernaussagen

  • In der Behandlung der Lungentuberkulose hat die chirurgische Therapie eine hohe Bedeutung, vor allem in der Therapie der Tuberkulosefolgeerkrankungen, akuter Komplikationen und zur Fokussanierung bei MDR-/XDR-Tuberkulose (MDR = Multidrug-resistant Tuberculosis; XDR = Extensively Drug-resistant Tuberculosis).

  • Thoraxchirurgen sollten mit interdisziplinären Behandlungskonzepten der Tuberkulose vertraut sein und moderne parenchymsparende Operationsverfahren beherrschen.

  • Eine besondere operative Expertise ist bei ausgedehnten Resektionen, vor allem bei „Destroyed Lobe/Lung“ und begleitender Aspergillose notwendig.

Schlüsselwörter

Tuberkulose - spezifisches Empyem - Bronchiektase - Hämoptyse

Key words

tuberculosis - specific empyema - bronchiectasis - hemoptysis
 

  • Literatur

  • 1 Moran Jon F. Surgical Treatment of pulmonary Tuberculosis. In: Sabiston DC, Spencer FC. eds. Surgery of the Chest. Philadelphia: Saunders; 1995: 752-772
    Search in Google Scholar
  • 2 Reed CE, Parker EF, Crawford FA. Surgical resection for complications of pulmonary tuberculosis. Ann Thorac Surg 1989; 48: 165-167
    CrossrefPubMedSearch in Google Scholar
  • 3 Schaberg T, Bauer T, Brinkmann F. et al. Tuberkulose im Erwachsenenalter. Leitlinie zur Diagnostik und Therapie, einschließlich Chemoprävention und -prophylaxe. Eine Leitlinie des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose e.V. im Auftrag der Deutschen Gesellschaft für Pneumologie e.V. Pneumologie 2017; 71: 1-72
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Yablonski P, Cordos I, Sokolovich E. et al. Surgical Treatment of pulmonary Tuberculosis. In: Rohde G. Dragon Subotic, Complex pleuropulmonary Infections. European Respiratory Monograph 61. Sheffield: European Respiratory Society; 2013: 20-36
    Search in Google Scholar
  • 5 Park S-K, Kim J-H, 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: 170-175
    CrossrefPubMedSearch in Google Scholar
  • 6 Brown J, Pomerantz M. Extrapleural pneumonectomy for tuberculosis. Chest Surg Clin N Am 1995; 5: 289-296
    PubMedSearch in Google Scholar
  • 7 Rizzi A, Rocco G, Robustellini M. et al. Results of surgical management of tuberculosis: Experience in 206 patients undergoing operation. Ann Thorac Surg 1995; 59: 896-900
    CrossrefPubMedSearch in Google Scholar
  • 8 Kato A, Kudo S, Matsumoto K. et al. Bronchial artery embolization for hemoptysis due to benign diseases: immediate and long-term results. Cardiovasc Intervent Radiol 2000; 23: 351-357
    CrossrefPubMedSearch in Google Scholar
  • 9 Uflacker R, Kaemmerer A, Neves C. et al. Management of massive hemoptysis by bronchial artery embolization. Radiology 1983; 146: 627-634
    CrossrefPubMedSearch in Google Scholar
  • 10 Swanson KL, Johnson CM, Prakash UBS. et al. Bronchial artery embolization: experience with 54 patients. Chest 2002; 121: 789-795
    CrossrefPubMedSearch in Google Scholar
  • 11 Fernando HC, Stein M, Benfield JR. et al. Role of bronchial artery embolization in the management of hemoptysis. Arch Surg 1998; 133: 862-866
    CrossrefPubMedSearch in Google Scholar
  • 12 Van den Heuvel MM, Els Z, Koegelenberg CF. et al. Risk factors for recurrence of haemoptysis following bronchial artery embolisation for life-threatening haemoptysis. Int J Tuberc Lung Dis 2007; 11: 909-914
    PubMedSearch in Google Scholar
  • 13 Dewan RK. Surgery for pulmonary tuberculosis – a 15-year experience. Eur J Cardiothorac Surg 2010; 37: 473-477
    PubMedSearch in Google Scholar
  • 14 Van Leuven M, De Groot M, Shean KP. et al. Pulmonary resection as an adjunct in the treatment of multiple drug-resistant tuberculosis. Ann Thorac Surg 1997; 63: 1368-1372
    CrossrefPubMedSearch in Google Scholar
  • 15 Ziegler R, Just H-M, Castell S. et al. Infektionsprävention bei Tuberkulose: Empfehlungen des DZK. Pneumologie 2012; 66: 269-282
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Xu H-B, Jiang R-H, Li L. Pulmonary resection for patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. J Antimicrob Chemother 2011; 66: 1687-1695
    CrossrefPubMedSearch in Google Scholar
  • 17 Pomerantz M, Madsen L, Goble M. et al. Surgical management of resistant mycobacterial tuberculosis and other mycobacterial pulmonary infections. Ann Thorac Surg 1991; 52: 1108-1111 discussion 1112
    CrossrefPubMedSearch in Google Scholar
  • 18 Man MA, Nicolau D. Surgical treatment to increase the success rate of multidrug-resistant tuberculosis. Eur J Cardiothorac Surg 2012; 42: e9-e12
    CrossrefPubMedSearch in Google Scholar
  • 19 Kir A, Inci I, Torun T. et al. Adjuvant resectional surgery improves cure rates in multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg 2006; 131: 693-696
    CrossrefPubMedSearch in Google Scholar
  • 20 Shiraishi Y, Katsuragi N, Kita H. et al. Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg 2009; 138: 1180-1184
    CrossrefPubMedSearch in Google Scholar
  • 21 Mohsen T, Zeid AA, Haj-Yahia S. Lobectomy or pneumonectomy for multidrug-resistant pulmonary tuberculosis can be performed with acceptable morbidity and mortality: a seven-year review of a single institutionʼs experience. J Thorac Cardiovasc Surg 2007; 134: 194-198
    CrossrefPubMedSearch in Google Scholar
  • 22 Kang M-W, Kim HK, Choi YS. et al. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg 2010; 89: 1597-1602
    CrossrefPubMedSearch in Google Scholar
  • 23 Wang H, Lin H, Jiang G. Pulmonary resection in the treatment of multidrug-resistant tuberculosis: a retrospective study of 56 cases. Ann Thorac Surg 2008; 86: 1640-1645
    CrossrefPubMedSearch in Google Scholar
  • 24 Massard G, Olland A, Santelmo N. et al. Surgery for the sequelae of postprimary tuberculosis. Thorac Surg Clin 2012; 22: 287-300
    CrossrefPubMedSearch in Google Scholar
  • 25 Karakoc GB, Yilmaz M, Altintas DU. et al. Bronchiectasis: Still a problem. Pediatr Pulmonol 2001; 32: 175-178
    CrossrefPubMedSearch in Google Scholar
  • 26 Haciibrahimoglu G, Fazlioglu M, Olcmen A. et al. Surgical management of childhood bronchiectasis due to infectious disease. J Thorac Cardiovasc Surg 2004; 127: 1361-1365
    CrossrefPubMedSearch in Google Scholar
  • 27 Ashour M, Al-Kattan K, Rafay MA. et al. Current surgical therapy for bronchiectasis. World J Surg 1999; 23: 1096-1104
    CrossrefPubMedSearch in Google Scholar
  • 28 Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respirat Med 2007; 101: 1163-1170
    PubMedSearch in Google Scholar
  • 29 Munro NC, Cooke JC, Currie DC. et al. Comparison of thin section computed tomography with bronchography for identifying bronchiectatic segments in patients with chronic sputum production. Thorax 1990; 45: 135-139
    CrossrefPubMedSearch in Google Scholar
  • 30 Young K, Aspestrand F, Kolbenstvedt A. High resolution CT and bronchography in the assessment of bronchiectasis. Acta Radiol 1991; 32: 439-441
    CrossrefPubMedSearch in Google Scholar
  • 31 Eren S, Esme H, Avci A. Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis. J Thorac Cardiovasc Surg 2007; 134: 392-398
    CrossrefPubMedSearch in Google Scholar
  • 32 Massard G. Treatment of suppurative Lung Disease. In: Verleden GM, Van Raemdonck D, Lerut T, Demedts M. Surgery for non-neoplastic Disorders of the Chest: a clinical Update. Sheffield: European Respiratory Society; 2004: 168-181
    Search in Google Scholar
  • 33 Van der Bruggen-Bogaarts BA, van der Bruggen HM, van Waes PF. et al. Assessment of bronchiectasis: comparison of HRCT and spiral volumetric CT. J Comput Assist Tomogr 1996; 20: 15-19
    CrossrefPubMedSearch in Google Scholar
  • 34 Swoboda L, Laule K, Blattmann H. et al. Dekortikation beim chronischen Pleuraempyem. Lungenfunktionsuntersuchungen unter besonderer Berücksichtigung des Perfusionsszintigramms. Helv Chir Acta 1991; 57: 631-636
    PubMedSearch in Google Scholar
  • 35 Olgac G, Yilmaz MA, Ortakoylu MG. et al. Decision-making for lung resection in patients with empyema and collapsed lung due to tuberculosis. J Thorac Cardiovasc Surg 2005; 130: 131-135
    Thieme ConnectPubMedSearch in Google Scholar
  • 36 Odell JA, Henderson BJ. Pneumonectomy through an empyema. J Thorac Cardiovasc Surg 1985; 89: 423-427
    PubMedSearch in Google Scholar
  • 37 Watanabe M, Hasegawa N, Ishizaka A. et al. Early pulmonary resection for Mycobacterium avium complex lung disease treated with macrolides and quinolones. Ann Thorac Surg 2006; 81: 2026-2030
    CrossrefPubMedSearch in Google Scholar
  • 38 Dezfouli AA, Kakhki AD, Farzanegan R. Results of lobectomy and pneumonectomy in pulmonary TB. Tanaffos 2003; 2: 33-39
    PubMedSearch in Google Scholar
  • 39 Fujimoto T, Zaboura G, Fechner S. et al. Completion pneumonectomy: current indications, complications, and results. J Thorac Cardiovasc Surg 2001; 121: 484-490
    CrossrefPubMedSearch in Google Scholar
  • 40 Schönfeld N, Haas W, Richter E. et al. Empfehlungen zur Diagnostik und Therapie nichttuberkulöser Mykobakteriosen des Deutschen Zentralkomitees zur Bekämpfung der Tuberkulose (DZK) und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). Pneumologie 2013; 67: 605-633
    Thieme ConnectPubMedSearch in Google Scholar
  • 41 Khan R, Harris SH, Verma AK. et al. Cervical lymphadenopathy: scrofula revisited. J Laryngol Otol 2009; 123: 764-767
    CrossrefPubMedSearch in Google Scholar