دور الجراحة في علاج الاصابات الدرنية الصدرية

Background & Objective: Tuberculosis is still a worldwide disease. Medical treatment is essential but surgery still has a role in the diagnosis and treatment of several various thoracic tuberculous lesions (both pulmonary and extra-pulmonary). We aim to present and analyzethe results of surgical treatment of thoracic tuberculous cases in Al-Assad University Hospital in Damascus. Also, we purpose to determine the indications of thoracoscopic and traditional surgical interventions in this field, and studying their complications. Material& methods: The study consists of two sections: retrospective (from 1992 till end of 2007), prospective (from 2008 till end of 2010), includes all patients with thoracic tuberculous infections _ pulmonary or extra-pulmonary_diagnosed and treated in the department of thoracic Surgery in Al-Assad University Hospital in Damascus (301 patients), who underwent thoracoscopic and traditional thoracic surgical interventions. Results: Pulmonary tuberculous cases compose 34.5% vs. 65.5% extra-pulmonary tuberculous cases (pleural 39.6%, mediastinal lymph nodes 12.9%, chest wall 9.3%, pericardial 3.6%). The proportion of thoracoscopic interventions was 36.5%: majority of them were diagnostic (61.8%), whereas the proportion of traditional thoracic interventions was 63.5%: majority of them were therapeutic (75.9%) to management complicated or neglected or incorrectly treated cases. The diagnosis of tuberculosis was not confirmed in80% of patients at admittance. Majority of cases (88.4%) had active tuberculosis vs. 11.6% only had sequelae of previous tuberculous infection.Morbidity rate was 7.3%, and mortality rate was 1.3%. Conclusion: Surgery still plays an important role in diagnosis and treatment of thoracic tuberculosis _pulmonary or extra-pulmonary_ and management of their complications. Also, We consider thoracoscopy as a selective mini-invasive option for diagnosing and treatingthese cases