Surgical management of tuberculosis-related hemoptysis.
BACKGROUND
Tuberculosis is a disease that is often treated with chemotherapy. However, medical treatment usually fails in the management of tuberculosis-related hemoptysis. In this paper, we review our experience in the surgical treatment of tuberculosis-related hemoptysis.


METHODS
Fifty-nine patients with tuberculosis-related hemoptysis (46 men, 13 women) who underwent surgical treatment were enrolled in this study. A thoracotomy was performed urgently in 21 patients with massive (>600 mL daily) hemoptysis, and within the first 2 days in 24 with major (200 to 600 mL daily) hemoptysis, and within the first 4 days in 14 with persistent minor (<200 mL daily) hemoptysis.


RESULTS
A chest roentgenogram showed cavitary lesion in all of the patients with massive hemoptysis (21 patients), in 22 of 24 patients with major hemoptysis, and in 3 of 14 patients with persistent minor hemoptysis. Pneumonectomy was performed in 4 patients, lobectomy in 39 patients, and segmentectomy or wedge resection in 16 patients. The average hospitalization period was 13 days. The mortality rate was 6.8% perioperatively. Of the patients deceased, 3 were intubated with a single-lumen endotracheal tube and 1 with a double-lumen endotracheal tube. During the postoperative period, empyema and bronchopleural fistula developed in 3 patients, and no other severe complications occurred. The average postoperative follow-up period was 3 years. The number of thoracotomies for tuberculosis performed in the years from 1995 to 2003 was significantly decreased, compared with the years between 1985 to 1994 (p = 0.042).


CONCLUSIONS
In tuberculosis-related hemoptysis, thoracotomy with double-lumen endotracheal intubation and resection of the cavity may be curative and lifesaving.
Erdogan
Abdullah
A
Department of Cardiothoracic Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey. aerdogan66@hotmail.com
Yegin
Arif
A
Gürses
Gülsüm
G
Demircan
Abid
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents / Q000627:therapeutic use; D001237:Asphyxia / Q000209:etiology / Q000401:mortality; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012074:Remission Induction; D013524:Surgical Flaps; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents