[Surgical treatment of bronchopleural complications after lung resection and pleurectomy in patients with tuberculosis]. / Khirurgicheskoe lechenie bronkhoplevral'nykh oslozhnenii posle rezektsii legkogo i plevrektomii u bol'nykh tuberkulezom.

OBJECTIVE: To increase an efficiency of surgical treatment of bronchopleural complications after lung resections and pleurectomies through the development of modern indications, treatment strategies, techniques and postoperative management. MATERIAL AND METHODS: We analyzed data in 252 patients with bronchopleural complications after lung resections and pleurectomies. The study included patients who underwent treatment at the Central Research Institute of Tuberculosis for the period 2004-2010, Clinical Hospital of Phthisiopulmonology of the Sechenov First Moscow State Medical University for the period 2011-2017 and Thoracic Center of the Republic of Ingushetia for the period 2015-2019. The study included patients with postoperative pleural empyema divided into two groups: group I - 138 patients with empyema and bronchial fistula; group II - 114 patients with empyema and no bronchial fistula. In the 1st group, 1 patient had bronchial and esophageal fistulas. RESULTS: At discharge, empyema and bronchial fistula were eliminated in 245 (97.2%) patients of both groups. Overall in-hospital mortality was 1.6% (4 cases). Two (1.4%) patients died within 30 days in group I and 1 (0.9%) patient died in group II. Within 90 days after surgery, another patient died from acute cerebrovascular accident in group I. In long-term period, overall effectiveness of treatment of bronchopleural complications was 97.2% (208 out of 214 cases). CONCLUSION: The original surgical approach for bronchopleural complications considers timing of postoperative empyema, its spread and duration. This method together with minimally invasive interventions reduces mortality and ensures stable recovery after bronchopleural complications in 97.2% of patients.

[Surgical collapse in the treatment of single lung tuberculosis]. / Kollapsokhirurgicheskie operatsii v lechenii destruktivnogo tuberkuleza edinstvennogo legkogo.

OBJECTIVE: To improve the treatment of destructive tuberculosis of a single lung by using of collapse surgery. MATERIAL AND METHODS: The authors analyzed an experience of collapse surgery for destructive tuberculosis of a single lung. RESULTS: Collapse surgery was effective in 77.5% of patients. CONCLUSION: Endoscopic surgical collapse improves the outcomes in patients with destructive tuberculosis of a single lung and expands the possibilities for surgery in these patients when resection is not applicable.

[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.

[Surgical treatment of tuberculous empyema in children]. / Khirurgicheskoe lechenie tuberkuleznoi émpiemy plevry u detei.

OBJECTIVE: To analyze surgical treatment of tuberculous pleural empyema in children depending on the stage of the process. MATERIAL AND METHODS: There were 82 patients aged 4-17 years with tuberculous pleural empyema. Clinical and X-ray features of different stages of disease are described. Certain types of surgical interventions at each stage of the process are analyzed. RESULTS: In 72 children with empyema stage III 76 surgeries were performed. Postoperative complications occurred in 2 (2.6%) cases (delayed lung inflation) that required thoracocentesis with pleural drainage. There was no postoperative mortality. CONCLUSION: Complex treatment of tuberculous pleural empyema in children and adolescents with the use of modern surgical methods is followed by satisfactory outcomes in all patients. However, surgical technique, postoperative morbidity and hospital-stay depend on the stage of the process. Unfortunately, almost 90% of patients had empyema stage III. Therefore, minimally invasive surgery was not advisable and extensive, traumatic surgeries were required.

[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.

[Repeated lung resection in patients with postoperative recurrent tuberculosis in the operated lung].

The literature data of 18 authors about surgical treatment of 1723 patients with recurrent tuberculosis are presented in the article. Also authors reported their own experience in repeated lung resection in 50 patients. Intraoperative complications were observed in 7 patients including empyema cavity dissection in 2 cases, scalping lung injury in 2 cases, peristump abscess dissection in 1 case, v. azygas injury in 1 patient and rupture of membranous part of trachea due to swollen cuff of intubation tube in 1 case. In postoperative period complications developed in 5 patients including early intrapleural bleeding in 1 case, later intrapleural bleeding in 1 case, empyema with bronchial fistula in 1 patient, residual pleural cavity in 1 patient and wound complication in 1 case. All postoperative complications were eliminated and there was no postoperative mortality. The authors concluded that although severe patients' condition, technical complexity and higher surgical risk of repeated resections compared with organ-preserving and collapsosurgical interventions satisfactory remote results and high proportion of labour rehabilitation earnestly prove advantages of repeated lung resections for recurrent tuberculosis of operated lung.

[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.

[Miniinvasive video-assisted accesses in thoracic surgery].

Personal 10-year experience of 2412 operations on the thorax is summarized. 1394 (57,8%) of interventions were performed videothoracoscopically. Technical aspects of gross videothoracoscopic operations (552 lung resections and 162 pneumonectomies), indications for the use of the method are discussed. Own results are supplemented with meta-analysis of the literature.

[Comparison of radionuclide studies with pleural morphological changes in patients with tuberculosis pleurisy].

Forty-seven patients with pleurisy of tuberculous etiology underwent a radionuclide study using the reagent 99mTc-labeled technefit, the result of which was compared with the morphological changes in the pleural biopsy or resection specimens. First-degree pleural resorptive dysfunction (PRD) was ascertained in 27.6% of the patients. Morphologically, there were signs of acute edema of all pleural layers in both the area of inflammation and the proximal portions with reduced vessels in the microcirculatory bed (MCB). These patients had medical treatment. 59.6% of patients had second-degree PRD--circumscribed caseous foci and granulomas were morphologically found in the presence of progressive fibrosis with a small number of vessels in the MCB. 12.8% of patients had third-degree PRD--massive pleural fibrosis with a significant reduction in MCB vessels and lymph capillaries. Active tuberculous inflammation remained mainly in the deep layers of the pleura. Surgical treatment was performed in patients with second-third degree PRD. Thus, comparison of the results of a radionuclide study with morphological changes in the tuberculosis-afflicted pleura made it possible to establish the degree of pleural MCB impairments, to characterize the activity of a pathological process, and to define objectively treatment policy.

[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.

[Efficiency of partial pneumonectomies in patients with multidrug-resistant tuberculosis].

The immediate results of partial resections were analyzed in 120 patients with drug-resistant pulmonary tuberculosis, among whom 70 patients had multidrug resistance. A complete clinical effect (abacillation and no decay cavities) was achieved in 117 (97.5%) patients, including in 67 (95.7%) patients with multidrug resistance who showed improvement in 3 (2.5%) cases, fatal outcomes being absent.

[The first experience with video-assisted thoracoscopy used during operations in children and adolescents for pulmonary tuberculosis].

The paper first describes the experience in performing operations in 34 children and adolescents with different forms of tuberculosis of the lung and intrathoracic lymph nodes via mini-invasive access (a 4-6-cm skin cut), by applying video-assisted thoracoscopy. Practice has provided evidence that lung resections of any scope can be made in children and adolescents with pulmonary tuberculosis and nonspecific lung diseases during video-assisted thoracoscopic operations. The latter have a lot of advantages over the traditional thoracic operations; these included decreases in the duration of operations, in intraoperative and early postoperative blood and plasma losses and the duration of inpatient treatment of pulmonary tuberculosis in children and adolescents, and earlier activation.

[Outcomes of video-assisted thoracic lung resections and pneumonectomies in patients with pulmonary tuberculosis].

The paper pools some experience with 6 videothoracoscopic and 505 video-assisted thoracoscopic (VATS) resections of the lung and 105 VATS pneumonectomies. The bulk of the operations [451 (73.2%)] was made for pulmonary tuberculosis in patients aged 7 to 77 years. 81% operations by separately treating root elements, including all pneumonectomies and major lung resections, were performed. A new SOMI-80 suturing apparatus designed for mini-invasive surgery was employed to suture lung tissue in most cases. Intraoperative and postoperative complications occurred in 5 and 8 cases, respectively. The efficiency of operations for tuberculosis was 98.6%.

[Surgical treatment of patients with acute pulmonary tuberculosis]. / Khirurgicheskoe lechenie bol'nykh ostroprogressiruiushchim tuberkulezom legkikh.

The immediate and late outcomes of treatment of acute pulmonary tuberculosis with and without surgical treatments (337 and 271 patients, respectively) were analyzed. The vast majority of patients in both groups were those with caseous pneumonia and fibrocavernous tuberculosis complicated by caseous pneumonia. A complete clinical effect was achieved in 14% of non-operated patients at their discharge, with a hospital mortality of 15.5%. A surgical treatment provided a 6.5-fold early effectiveness with a less (8.6-fold) hospital mortality. In a follow-up periods (up to 11 years), the number of cases of recurrences and progression of tuberculosis in patients in whom surgery was indicated, but non operated cases was 5.7 times higher than that in those radically and arbitrarily radically operated on; 5-, 7-, and 10-year survival rates in the non-operated patients were 1.6, 2.3, and 4.9 times less, respectively (85.7% versus 17.6%).

[Treatment of patients with destructive pulmonary tuberculosis with concomitant diabetes mellitus]. / Lechenie bol'nykh destruktivnym tuberkulezom legkikh s soputstvuiushchim sakharnym diabetom.

Diabetes mellitus accompanying tuberculosis complicates the course of the latter and remains a topical problem of phthisiology. Surgical treatment of patient with both conditions presents a high risk and is employed unreasonably rarely. The results of medical (173 patients) and surgical (107 patients) treatments were studied in patients with destructive tuberculosis concurrent with diabetes mellitus. Analyzing early and late results of treatment showed a more steady-state effect in the group of surgically treated patients. Thus, surgery should be desirably used in all patients with preserving destructive changes after the basic course of antibacterial therapy.