CONTROVERSIES ON THE OPERATIVE MOMENT IN PLEURO-PULMONARY TUBERCULOSIS

摘要

THE CLASSICAL STANDPOINT IN PHTISIO-SURGERY STATES THAT IT IS COMPULSORY TO TREAT THE TB PATIENTS WITH ANTITUBERCULOUS DRUGS FOR 4 - 6 MONTHS BEFORE ENVISAGING A MAJOR OPERATIVE PROCEDURE. IN THIS ARTICLE WE REVIEW THE EXPERIENCES OF SEVERAL THORACIC SURGEONS WHO PERFORMED VARIOUS OPERATIONS FOR TB BEFORE THE ABOVE MENTIONED PERIOD OR EVEN WITHOUT A PRIOR CHEMOTHERAPY. THE RATIONALE BEHIND THIS AGGRESSIVE APPROACH IS BASED ON THE FOLLOWING: 1) EARLIER CURE FOR THE PATIENT WHO WAS OPERATED BEFORE COMPLETING THE STANDARD MEDICAL THERAPY, 2) THE LACK OF EFFICIENCY OF CHEMOTHERAPY IN MDR AND XDR CASES, AND 3) THE FAVORABLE OUTCOME, I.E. FEWER COMPLICATIONS AND FASTER SOCIAL REINSERTION OF THE CASES WHO RECEIVED EARLY SURGERY COMPARED TO THOSE TREATED MAINLY BY CHEMOTHERAPY. SOME AUTHORS POINT OUT THAT SUCH AN APPROACH IS LESS EXPENSIVE THAN THE CLASSICAL ONE. WE ALSO BRING INTO ATTENTION THE CONCEPT OF BIOCHEMICAL ”MARKERS” THAT MIGHT INFLUENCE THE DECISION TO PERFORM EARLIER SURGERY, ALTHOUGH THIS CONCEPT NEEDS MORE STUDIES AND REFINING.