[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.

[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.

[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.

[Efficiency of extrapleural thoracoplasty in pulmonary tuberculosis]. / Effektivnost' ékstraplevral'noi torakoplastiki pri tuberkuleze legkikh.

Under the present conditions, to improve surgical collapse techniques and to popularize their are a pressing task of phthisiology. Of 23,902 thoracic interventions made in the regional tuberculosis dispensary during 50 years, 1782 cases thoracoplasties were performed. By modifying the procedure of posterior upper extrapleural thoracoplasty, the authors could expand its use in patients with low functional reserves, including in those with bilateral destructive lesions. Promising results of its use in generalized destructive tuberculosis make extrapleural thoracoplasty the operation of choice in a great deal of patients.

[Results of pneumonectomy with resection of the tracheal bifurcation]. / Rezul'taty pnevmonèktomii s rezektsiei bifurkatsii trakhei.

The results of pneumonectomy with resection of tracheal bifurcation in 779 patients reported by 54 authors for the period of 44 years are reviewed. The analysis of all the data showed that this operation remains one of the most dangerous and rare surgical procedures. Lethality in total bifurcation resection averaged 24.3% and in partial resection--10.2%. Because of lack of experience there is no distinct indications for the operation in cancer patients. The authors have performed 111 pneumonectomies with bifurcation resection (39 with circulatory resection) with lethality of 2.7% and 5-year survival of 25%. This proves the ability of updated surgical technique to decrease surgical risk and extend indications for surgery of local cancer.

[Combined surgical treatment of malignant lung tumors]. / Kombinirovannye operatsii v lechenii zlokachestvennykh opukholei lëgkikh.

Two hundred-sixty four radical combined surgical operations (237 pneumonectomies and 27 lobectomies) were performed in 1981-1994. Two hundred-fifty four patients were operated on for cancer, 7-carcinoid and 3 patients for sarcoma. In 159 cases, tumors were identified as T3 and in 70 cases--as T4. Metastases into lymph nodes of the root and mediastinum--another 121 patients. Surgery alone was received by 90.5%. Mortality for the first 30 days was 1.9%. Twenty-six percent of patients with non-small cell carcinoma survived 5 years, small cell carcinoma-12.5% and carcinoid-100%. No significant difference in survival time was registered for T3 and T4 process.

[Immediate and long-term results of reconstructive surgery of the bronchi]. / Blizhaishie i otdalennye rezul'taty rekonstruktivnykh operatsii na bronkhakh.

Bronchial plastic reconstruction has been performed in 136 patients aged 8-82. Of them 86, 23, 1, 6, 13, 6, 1 had cancer, carcinoid, sarcoma, benign tumor, nonspecific stenosis, post-tuberculous stenosis, traumatic detachment of the main bronchus, respectively. The patients underwent: lobectomy (101 operations), bilobectomy (24 operations), bisegmental bronchial resections (2 operations), isolated bronchial resections (9 operations). An original technique of narrowing of the central stump in circulatory bronchial resections is described. Neither postoperative complications in anastomoses nor lethal outcomes were recorded. In all cases of nontumor stenosis and benign tumors functional benefits were achieved. A 5-year survival of cancer patients reached 66.7%. The procedures and surgical outcomes are discussed.