АБДОМИНАЛЬНЫЙ ТУБЕРКУЛЁЗ: ВОЗВРАЩЕНИЕ В ХИРУРГИЮ

Abstract

Objective: Еo determine the optimal tactics of diagnosis and surgical treatment of abdominal tuberculosis (AT). Methods: In the period from 2012 to 2018 years, 229 patients with AT were examined and operated in the Tuberculosis Surgery Department of the Clinic № 2 of the Moscow City Scientific and Practical Center for the Control of Tuberculosis. In the patient survey complex included polypositional X-ray and CT scan of the abdominal cavity and chest, ultrasound of the abdominal cavity, diagnostic video-laparoscopy, laboratory and morphological methods of examinations. A total of 345 operations were performed, including relaparotomy. The surgical interventions for all patients were carried out in terms from 6 to 68 hours from the moment of disease. Results: It was revealed that pulmonary tuberculosis was found in the vast majority of patients (n=207; 90.4%). HIV infection was also diagnosed in most patients (n=172; 75.1%). The most frequent indications for surgical treatment were peritonitis on the basis of perforations of tuberculous ulcers of various intestinal sections (n=89; 38.9%), peritoneal tuberculosis (n=52; 22.7%), acute intestinal obstruction of tubercular nature (n=56; 24.5%). These complications were the reasons for the holding of emergency or urgent operational benefits, often quite extended volume. Often, the diagnosis of AT in most patients was established on the basis of intraoperative findings. Assume the tuberculous nature of an urgent surgical disease were only available in patients with previously diagnosed pulmonary tuberculosis Conclusion: Not timely detection of surgical complications of tuberculosis of the abdominal organs due to the erosion of symptomatic, the lack of alertness among surgeons regarding AT, defines the low efficiency of surgical treatment and the inadequacy of surgical tactics. Lethality in patients in the postoperative period remains quite high (19.2%), mainly counting patients with developed secondary peritonitis on the background of perforation of the tubercular ulcers of the intestine (28.1%). AT should be considered as a surgical problem, especially in cases of complications development. To solve the problems of early diagnosis of the patients with suspected tuberculosis of the abdominal cavity organs should be observed jointly by the surgeon and a phthisiatrician. Keywords: Abdominal tuberculosis, peritoneal tuberculosis, ulcer perforation, HIV infection.