Abstract
BackgroundTo evaluate the efficacy and safety of surgical treatment of tuberculosis destroyed lung (TDL), and the influence of chronic pulmonary aspergillosis (CPA) on the outcomes of surgical treatment of TDL.MethodsWe performed a retrospective analysis of 113 patients with TDL who underwent surgical treatment from January 2005 to December 2019. Among them, 30 of these cases were complicated with CPA. The patients were divided into two groups: TDL group and TDL + CPA group. We analyzed the effectiveness and safety of surgical treatment of TDL, and further compared the effectiveness and safety of surgical treatment of TDL with or withoutthe presence of CPA.ResultsThe TDL + CPA group had a significantly higher age (P=0.003), symptoms of hemoptysis (P=0.000), and a higher proportion of patients with preoperative serum albumin <30 g/L (P=0.014) as compared with TDL group. For all enrolled patients, the incidence of severe postoperative complications was 12.4% (14/113) and the postoperative mortality within 30 days after discharge was 4.4% (5/113). 86.7% (98/113) of the patients recovered and discharged, the incidence of severe postoperative complications in the TDA + CPA group was higher than that of TDL group (23.3% vs 8.4%, P = 0.034), although there was no difference in mortality between the two groups (P = 1.000). A binary logistic regression analysis showed that the independent risk factors for severe postoperative complications were male (OR 25.24, 95% CI 2.31–275.64; P = 0.008) and age ≥ 40 years (OR 10.34, 95% CI 1.56–68.65; P = 0.016).ConclusionSurgical treatment for patients with TDL is effective with an acceptable mortality rate whether or not the disease is complicated with CPA. The independent risk factors identified for severe postoperative complications in patients with TDL were male and ≥ 40 years old. It implies that when treating patients with TDA + CPA, particular attention should be paid to these patients who have these independent risk factors to avoid a poor outcome.
Highlights
Chronic lung infection can result in destroyed lung, characterized by diffuse lung structural damage, is more common in developing countries
The incidence of severe postoperative complications was 12.4% (14/113) and the postoperative mortality within 30 days after discharge was 4.4% (5/113). 86.7% (98/113) of the patients recovered and discharged, the incidence of severe postoperative complications in the TDA ? chronic pulmonary aspergillosis (CPA) group was higher than that of tuberculosis destroyed lung (TDL) group (23.3% vs 8.4%, P = 0.034), there was no difference in mortality between the two groups (P = 1.000)
Destroyed lung is an irreversible disease defined by radiology with the physiological characteristic of decreased ventilation/perfusion ratio, with the primary cause from pulmonary tuberculosis [2], that is common in countries with underdeveloped health systems [24]
Summary
Chronic lung infection can result in destroyed lung, characterized by diffuse lung structural damage, is more common in developing countries. The prevalence of CPA ranged from 6.3 to 13.7% in patients previously or currently being treated for tuberculosis [3], residual cavity is more susceptible to complications of chronic pulmonary as per gillosis (CPA) [4, 5]. The most common symptom of pulmonary tuberculosis and CPA is hemoptysis [6,7,8,9], and massive hemoptysis is an indication of surgical treatment [2, 10,11,12]. Many studies have shown that the surgical treatment of tuberculosis destroyed lung (TDL) or CPA is effective, with acceptable postoperative complications and mortality. To evaluate the efficacy and safety of surgical treatment of tuberculosis destroyed lung (TDL), and the influence of chronic pulmonary aspergillosis (CPA) on the outcomes of surgical treatment of TDL
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