Tuberculosis - I.T. Pyatnochka 2005

Tuberculosis treatment
Surgical treatment

Surgical Treatment of patients with Pulmonary Tuberculosis is an integral part of comprehensive management. Given the ongoing rise of the tuberculosis epidemic, The Role of surgery is set to grow.

Absolute indications for surgical treatment include:

1) persistent bacterial excretion after 6 months of antimycobacterial therapy in the presence of a cavity;

2) curable residual lesions—Bronchiectasis, destroyed lobe (lung), significant bronchial stenosis;

3) suspected coexistence of tuberculosis and a malignant neoplasm;

4) large fibro-caseous lesions (Tuberculoma, caseoma) without bacterial excretion;

5) life-threatening hemorrhages;

6) thin-walled cavities without bacterial excretion for epidemiological reasons (workers in childcare facilities).

The optimal timeframe for surgical treatment of pulmonary tuberculosis against the Background of intensive etiopathogenetic therapy is 3–9 months. Consequently, patients have the opportunity to complete a full primary course of antimycobacterial therapy, the failure of which serves as an indication for surgery. In addition, candidates for surgery must be in satisfactory general condition, without signs of cardiac decompensation, severe respiratory impairment, or irreversible Disorders of Other Internal Organs and systems. Surgical interventions are preferably performed during the phase of remission and stabilization of the tuberculous process. In emergency situations (Pulmonary Hemorrhage, tension pneumothorax, etc.), the acute phase of tuberculosis should not preclude surgical elimination of life-threatening symptoms.

Surgical Methods for treating pulmonary tuberculosis are classified into radical, collapse-surgical, and intermediate operations. Radical Procedures include segmentectomy, combined resection, lobectomy, pneumonectomy, and pleurectomy. Collapse surgery includes thoracoplasty. The intermediate group comprises direct procedures on the cavity (cavernostomy, cavernoplasty), and ligation of a bronchus or a branch of the pulmonary artery.

Indications for surgery in tuberculosis patients can be elective or emergency.

Visual and more specific indications, as well as The Nature of surgical intervention for Various Forms of respiratory tuberculosis, are presented in Table 10.

Class="center">Table 10 Indications for surgical treatment of patients with various forms of respiratory tuberculosis

Form of tuberculosis

Indications for surgery

Type of surgery

Primary tuberculosis complex, Tuberculosis of intrathoracic Lymph Nodes

Chronic intoxication.

Primary cavity or large tuberculoma. Large caseous lymph nodes, nodulobronchial fistula refractory to conservative treatment. Cicatricial bronchial stenosis. Pulmonary cirrhosis.

Segmentectomy or lobectomy. Removal of caseous nodes, broncholith, closure of bronchial fistula, conservative resection of the lung or bronchus.

Focal tuberculosis

Conglomerate of foci, persistent activity, frequent relapses. Patient's desire to continue employment incompatible with current health regulations.

Limited lung resection.

Tuberculoma

Intoxication. Bacterial excretion. Breakdown, progression. Multiple tuberculomas in a single lobe. Differential Diagnosis challenges (ruling out Cancer).

Limited lung resection. Lobectomy.

Caseous Pneumonia

Progressive course with no tendency toward demarcation

Lobectomy. Pulmonectomy.

Infiltrative tuberculosis in the breakdown phase.

Fibro-cavernous, cirrhotic tuberculosis

Prolonged bacterial excretion (> 4 months). Cavity in the middle or lower lobe of the lung. Cavity containing fungal balls, stenosis of the draining bronchus, destroyed lung. Giant cavity, multiple cavities in the lung or lobe. Cirrhotic tuberculosis with bronchiectasis, frequent exacerbations, hemoptysis, bacterial excretion, cicatricial stenosis of the main bronchus, bronchopleural fistula.

Lobectomy. Pulmonectomy. Thoracoplasty. Cavity drainage. Cavernostomy, cavernoplasty.

Chronic tuberculous empyema

Inability to re-expand the lung and achieve obliteration of the pleural cavity.

Pleurectomy with pulmonary decortication.


Last update: 10/08/2026

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