Pii: S1010-7940(00)00594-7

Background and objective: Conventionally, pulmonary resection with thoracoplasty is used to treat ®brocavernous complication of pulmonary tuberculosis. This operation is usually bloody, time-consuming with complicated postoperative course. To prevent massive blood loss and preserved pulmonary function, a more simpli®ed operative procedure, cavernostomy combined intrathoracic muscle ̄ap transposition was used and the outcome was evaluated in this study. Design: Retrospective review. Methodology: Between December 1989 and June 1996, a total of ten patients with ®brocavernous pulmonary tuberculosis were managed using cavernostomy combined with intrathoracic muscle ̄ap transposition. Five of them had concomitant aspergilloma within the cavity while three had multiple drug resistant pulmonary tuberculosis. The muscle ̄ap was used to plombage the cavity and reinforce the closure of bronchopleural ®stula after cavernostomy. Results: Six postoperative complications occurred in ®ve patients, including reformation of cavity (2), bronchopleurocutaneous ®stulae (3), and postoperative bleeding (1). The success or failure of intrathoracic muscle ̄ap transposition on patients with ®brocavernous tuberculosis was signi®cantly correlated with the size of the cavity (194:0 ^ 11:2 vs. 283:0 ^ 44:6 cm, P ˆ 0:016) and the number of bronchopleural ®stulae (1:6 ^ 0:4 vs. 4:0 ^ 0:4, P ˆ 0:008). There was no operative death and in long term follow-up, there was no recurrence of hemoptysis or deterioration of pulmonary function in the successful group of patients. Conclusions: Cavernostomy combined with intrathoracic muscle ̄ap transposition can be used to treat well-selected ®brocavernous pulmonary tuberculosis patients, except on patients with large size cavity, multiple bronchopleural ®stulae or multiple drug resistance tuberculosis. q 2000 Elsevier Science B.V. All rights reserved.