Clinical-morphological characteristics of surgical treatment of multidrug-resistant pulmonary tuberculosis in the last 10 years
Journal Title: Туберкульоз, легеневі хвороби, ВІЛ-інфекція - Year 2018, Vol 0, Issue 3
Abstract
Objective — to analyze the surgical activity in cases of pulmonary MDR-TB taking into account laboratory parameters over a 10-years period (based on the materials of a highly specialized NIFP clinic). Materials and methods. A retrospective study of surgical activity for pulmonary tuberculosis, in particular multidrug-resistant was performed for a 10-years period. A total of 1.038 operations were carried out, 366 of them (35.3 %) with pulmonary MDR-TB. All cases of multidrug-resistance have been verified microbiologically. During the study period, the dynamics of the annual frequency of operations and their types in pulmonary MDR-TB was analyzed, and also the frequency of different types of operations depending on the clinical and morphological form of MDR-TB, morphological activity in various forms of lung lesions, taking into account histological findings. The results of a microbiological study of the resistance profile of mycobacteria were taken into account. Results and discussion. The annual total number of operations for pulmonary TB has been presented and among them — the percentage of MDR-TB cases over a 10-year follow-up period. It is shown that overall the surgical activity has slightly decreased, while the specific weight of operations at MDR-TB is quite stable. The change in the types of surgical interventions in cases of MDR-TB has been established over time, in particular, the reduction in the number of large operations such as pneumonectomy, which the authors associate with the improvement of both the regimens of anti-tuberculosis chemotherapy, and with the introduction of video-assisted minimally invasive surgical procedures into surgical practice. Dependence of the type of surgical intervention on the clinical-morphological form of pulmonary TB and the degree of morphological activity of a specific inflammatory process at the time of surgery was analyzed. Tuberculomas and fibro-cavernous TB are prevailed among operated patients with MDR-TB, and in most cases of these forms of pulmonary TB the activity of tuberculous inflammation remains, 83 and 97 % respectively, according to morphological features. It was established that the microbiological detection of multidrug-resistant strains of MBT in the NIFP clinic in cases of pulmonary MDR-TB with surgical treatment was effective only in a third of all cases. Conclusions. In the past 10 years, the trend of reducing the number of pneumonectomies and increasing the number of operations of a more radical nature has been observed in surgery of pulmonary MDR-TB. Surgical interventions are indicated mainly in fibro-cavernous TB and pulmonary tuberculomas. According to the results of the morphological study, at the time of the operation, the activity of a specific process is retained in more than 80 % of cases, which indicates the need for complex, including surgical, treatment of such patients.
Authors and Affiliations
O. V. Tereshkovych, N. A. Hritsova, I. V. Liskina, L. M. Zahaba
Keywords
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- EP ID EP421390
- DOI 10.30978/TB2018-3-7
- Views 90
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