[Impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients]. / Vliyanie khirurgicheskoi sanatsii kontingentov bol'nykh destruktivnym tuberkulezom na osnovnye pokazateli rasprostranennosti i smertnosti ot tuberkuleza.

OBJECTIVE: To analyze the impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients. MATERIAL AND METHODS: Treatment strategy for destructive pulmonary tuberculosis de novo was developed in the Sechenov First Moscow State Medical University. This strategy was applied at the Surgical Department of the Regional Tambov Tuberculosis Dispensary in 2013-2017. We formed a register of patients with pulmonary destruction and bacterial excretion and developed a personal treatment plan. All patients were divided into 3 groups (group A - surgical treatment, group B - no surgery due to refusal or discontinuation of treatment, group C - patients with contraindications or no indications for surgical treatment). RESULTS: Treatment efficacy considering closure of destruction cavities and abacillation was maximal in group A - 97.2%, 41.4% in group B and 39.8% in group C. The number of patients with pulmonary destruction and bacterial excretion has decreased by 3.3 times (from 516 to 158) or 69.8% for 4 years of extensive application of surgical treatment protocol. A significant reduction of 'bacillary core' interrupted infection chain and affected the main epidemiological characteristics. Short-term reduction of the incidence of tuberculosis may be expected. However, even more significant impact of this factor should be expected in the long-term period. CONCLUSION: Surgical treatment of destructive pulmonary tuberculosis improves efficacy of the management of these patients and reduces mortality rate.

[Influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality]. / Vliianie khirurgicheskoi sanatsii kontingentov bol'nykh destruktivnym tuberkulezom na osnovnye pokazateli rasprostranennosti i smertnosti ot tuberkuleza.

OBJECTIVE: To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality. MATERIAL AND METHODS: The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment. RESULTS: Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up. CONCLUSION: Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.

[An experience of single lung resection and pneumonectomy after contralateral lung resection in treatment of tuberculosis].

AIM: To improve the efficiency of treatment of single lung destructive tuberculosis. MATERIAL AND METHODS: 15-year experience of operations for destructive tuberculosis performed by the same surgeon including 18 resections of the single lung and 19 pneumonectomies after previous partial lung resection is presented in the article. RESULTS: Surgical management of patients with destructive tuberculosis of single lung provides positive results in more than 90% of cases. However the frequency of its application is still low according to literature data. In case of destructive tuberculosis of single lung partial resection is more frequently indicated if fibrous-cavernous tuberculosis of the upper lung (up to 4 damaged segments), persistent bacterial excretion on the background of adequate chemotherapy and pathogen's drug resistance are present.

[Treatment of the newly diagnosed destructive lung tuberculosis with elimination of bacilli].

The study aimed to increase the efficacy of the newly diagnosed destructive lung tuberculosis with elimination of bacilli, using the collapsotherapeutic and surgical methods combined with intensive chemotherapy. 334 patients were diagnosed with lung tuberculosis in 2009 in Pensa region. Different methods of collapsotherapeutic and/or surgery were used in 255 (76.4%) patients. The comparative analysis of treatment results with patients, diagnosed with tuberculosis in 2006 and 2007 years, before the introduction of the new treatment modality, showed almost two-fold increase of the efficacy and 3-fold decrease of mortality rate.

[Clinicomorphological rationale for mediastinal lymphadenectomy in the surgical treatment of disseminated destructive pulmonary tuberculosis].

The paper analyzes morphological changes and results of surgical treatment in 515 patients with destructive pulmonary tuberculosis. Two hundred and seventy-four patients underwent mediastinal lymphadenectomy and in 241 patients lung resections or pneumonectomies were not followed by lymphadenectomy or solitary caseous molten lymph nodes were removed during an operation. In disseminated destructive pulmonary tuberculosis, active tuberculosis of intrathoracic lymph nodes (ILN) was found in 97%. The latter's significant signs are an enlarged lymph node of more than 2.0 cm, consolidation, periadenitis, and fluctuation. The incidence, extent, and pattern of ILN lesion varied in a lung tuberculous process depending on its site, form, and inflammation phase.