ПОДХОДЫ К ВЫБОРУ СРОКОВ ОПЕРАТИВНОГО ЛЕЧЕНИЯ ПРИ ТУБЕРКУЛЕЗНОМ ПОРАЖЕНИИ ПЛЕВРЫ У ДЕТЕЙ В УСЛОВИЯХ РОСТА ЗАБОЛЕВАЕМОСТИ ТУБЕРКУЛЕЗОМ С МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ

Abstract

Objective: to develop criteria for timing of surgical management of paediatric tuberculous pleurisy in the context of growing incidence of multidrug-resistant TB. Materials and methods. We analyzed case histories of 39 children aged 3–12 years treated in our hospital for tuberculous pleurisy in 2010–2019. Criteria for optimal timing of surgery for tuberculous pleurisy in children were elaborated considering clinical features and imaging-based examinations before and during TB treatment. Results. We developed criteria for timing of surgical management of paediatric tuberculous pleurisy. Thirty-one patients underwent surgery for tuberculous pleural empyema before TB treatment (6 patients), 2 months after TB treatment initiation (22 patients), and 6 or more months after TB treatment initiation (3 patients). Eight children with tuberculous exudative pleurisy did not need surgery. Conclusion. Surgical management before TB treatment is indicated for the combination of the following criteria: single or multiple pleural encapsulations detected by imaging-based examinations, lack of dominating TB processes in other anatomical sites. Surgical management after 2–3 months of TB treatment is indicated if exudative pleurisy transforms into pleural empyema in the absence of dominating TB processes in other anatomical sites. Surgical management after 6 or more months of TB treatment is indicated in the presence of a dominating TB process in the lungs after its stabilization.Keywords: TB, pleurisy, pleural empyema, children, surgery, multidrug resistance