Abstract
A clinical study of 71 cases of pulmonary tuberculosis that had had surgical resection during the period of 7 years and 6months from January 1989 to June 1996 in National Masan Tuberculosis Hospital. The results were as follows. 1. The ratio of male to female was 3.7:1 and in the age incidence the fourth decade was 22%, the third decade 15%. Although medical treatment was performed for more than 3 to 6 months, preoHeratively the conversion failure rate of positive sputum to negative state was 66.2%(47 cases). Of the failure cases, multiple-drug-resistant(MDR) patients were 41 cases(87.2%), 3. In MDR group, preoperatively conversion failure rate was 71.9%. 4. From the view of indica ion for lung resection on the radiographic finding, cavitary lesions were 43 cases(60.6%), destroyed lung lesions were 24 cases(33.8%). 5. The incidence of postoperative complication was 28.2%(20 cases). All cases were MDR 6. group and the most common of complication was tuberculosis spreading. In bilateral lesion, incidence of postoperative tuberculosis spreading was 25%(7 cases). Of the 7 cases, there was the cavitary lesion in 6 cases(86.7%). Total conversion rate of AFB positive sputum to negative state related to resectional sugery was 76.6% and in MDR group conversion rate of AFB positive sputum to negative state was 73.2% Conversion rate of MDR group with bilateral lesion was the lowest(60%). Conversion rate of drug-sensitivity group was 100% regardeless of lesions Slt to. In conclusion, despite of long-standing medical treatment, it is difficult to converse sputum-positive to negative state in multiple-drug resistance patients and that increases postoperative complications su h as tuberculosis relapse as a lack of appropriate drugs postoperatively. Postoperative conversion rate of sputum-positive to negative state was decreased in multiple-drug resistance patients. Because multiple-drug resistance patients have inireased due to several factors in Korea, it is important to prevent spreading of multiple-drug resistnce patients through the aggressive operative treatment. When the first medical therapy is fail or drug-resistance is found, operative treatment should be considered with the secondary medical therapy. The operation should be aggressively attempted even though at first medical treatment if indicated.
공동성 병소나 파괴된 폐를 적절한 시기에 제거하므로 다제내성환자와 중증환자의 양산을 감소시킬 수 있으리라는 관점에서 1989년 1월부터 1996년 6월 사이 7년 5개월간 본원에서 시행한 폐결핵환자 70명에대한 폐절제수술 71례를 대상으로 임상적으로 분석하였다. 1. 3~6개월간의 약물치료에도 불구하고 수술전 균음전화 실패을은 66.2%였고 균음전화 실패환자의 87.2%가 다제내성환자였다. 2. 다제내성군의 경우, 술전 균음전화 실패율은 71.9%였다. 3. 방사선 소견에 따른 폐절제술의 적응증은 공동성 병변이 43례(60.6%), 파괴폐가 24례(33.8%)였다. 4. 수술후 합병증은 20례(28.2%)에서 나타났으며 전례가 다제내성군이었다. 합병증 중에서 가장 흔한 것은 결 핵병변 확산이었다. 5. 양측성 병변에서,술후 결핵병변 확산은 7례(25%)에서 나타났으며 이 중 65례(85.7%)는 공동성 병변이었다. 6. 술전 균음전화에 실패한 47례의 폐절제술후 36례에서 균음전화(76.6%)되었으며, 다제내성군에서는 균음전 율이 73.2%였다. 약제내성군이면서 양측성 폐결핵의 경우 균음전율이 가장 낮았다(60%). 반면 약제 감수 성군에서의 균음전율은 위치에 관계없이 100%였다. 결국, 다제약제내성환자는 장기적인 약물치료에도 불구하고 술전에 균음전화 시키기가 어려울뿐 아니라, 술후 적절한 약제의 부족으로 재발등.수술후 합병증의 발생율을 높이고,술후 균음전화율을 감소시킨다. 여러 가지 이유로 다제내성환자의 증가가 문제인 우리나라\ulcorner서 다제내성환자에 대한 수술과 함께 다제내성환 자와 중증환자의 양산을 막는 것이 근본적인 해결책이라 생각되며 그 방법 중의 하나로 1차 결핵약제에 치 료를 실패했거나 내성을 가진 경우 2차 치료와 함께 수술을 고려해야 하며, 1차 치료 중이라도 수술 .적응이 되면 적극적으로 수술 치료를 시도해야 할 것으로 생각된다.