Assuntos
Infecções Bacterianas , Imunoglobulina A , Imunoglobulina M , Pneumonectomia/métodos , Complicações Pós-Operatórias , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Pulmonar/cirurgia , Adulto , Infecções Bacterianas/etiologia , Infecções Bacterianas/imunologia , Infecções Bacterianas/prevenção & controle , Feminino , Humanos , Imunoglobulina A/administração & dosagem , Imunoglobulina A/efeitos adversos , Imunoglobulina M/administração & dosagem , Imunoglobulina M/efeitos adversos , Imunoterapia/métodos , Infusões Intravenosas , Masculino , Monitorização Imunológica , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
The results of surgical treatment were analyzed in 481 patients who had been preoperatively found to have drug resistance. Patients with fibrocavernous, cirrhotic tuberculosis, chronic pleural empyema, and cavernous pneumonia constituted the vast majority (83.2%). Chemotherapy was performed by individual schemes, by taking into account MBT susceptibility. Glutoxim and pentaglobin were used as pathogenetic therapy for immunity correction. Resection-type operations [n = 368 (68.9%)], thorocoplastic interventions [n = 78 (14.6%)], thoracostomy or cavernostomy [n = 35 (6.5%)], pleurectomy [n = 26 (4.9%)], operation on the stump of the main bronchus [n = 15 (2.8%)], and mediastinal lymphadenectomy [n = 12 (2.2%)] were predominant. Postoperative complications occurred in 15.5% of cases; mortality was 1.7%. The mycobacterium resistance to drugs verified by laboratory studies exerted no evident impact on the number and pattern of postoperative complications. The results of treatment depended on the extent and presence of complications of a tuberculous process, comorbidity, suppressed immunity, and the scope of a surgical intervention.
Assuntos
Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Mycobacterium tuberculosis/isolamento & purificação , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Pulmonar/cirurgia , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Adulto JovemRESUMO
The authors present concise data on the history of surgical treatment for pulmonary tuberculosis at the Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy (1918-2008). They analyze the results of surgical treatment in 1007 patients with different forms of pulmonary tuberculosis in the past 10 years. The most common indications for surgical treatment are tuberculoma (44.2%), fibrocavernous and cirrhotic tuberculosis (37.8%), chronic pleuritis and pleural empyema (7.3%). There are prevalent resection-type operations (77.7%), with fatal cases after pneumonectomy (3.9%), lobectomy (0.6), and minor resections (0%). The proportion of thorocoplastic operations was 4.1% without fatal cases. Mini-invasive surgery using video-assisted technologies have received wide recognition in the diagnosis and surgical treatment of pulmonary tuberculosis. The results of treatment depend on the extent and presence of complications of a tuberculous process, comorbidity, suppressed immunity, and the scope of a surgical intervention. Overall, the efficiency of surgical treatment of patients with pulmonary tuberculosis is 90% or more.
Assuntos
Academias e Institutos/história , Pesquisa Biomédica/história , Infectologia/história , Pneumologia/história , Tuberculose Pulmonar/história , História do Século XX , História do Século XXI , Humanos , MoscouRESUMO
Ninety-four children and adolescents with tuberculosis of intrathoracic lymph nodes (TITLN) were operated on. Late diagnosis and long-term ineffective antituberculous therapy (chemotherapy lasted 2-3 years in 29.8% and 4-5 years in 19.1%) lead to the occurrence of complicated forms of TITLN in 34% of children. Computed tomography (CT) reliably determines the extent, site, and phase of a tuberculous process, assesses the time course of changes in the efficiency of antituberculous therapy. CT aids in defining the optimal time of surgical interventions. Bilateral consecutive one-stage removal of affected lymph nodes is possible in children with bilateral TITLN.
