A modern approach to surgical tactics in patients with residual post-tuberculosis changes of lungs

Abstract

In patients with residual changes after the treatment of destructive forms of tuberculosis (TB), the risk of recurrence of the disease increases significantly. The study of the surgical material of patients with pulmonary TB as a result of the progression of residual post-tuberculosis changes a year or more after the completion of anti-tuberculosis therapy makes it possible to justify the need for surgery in this category of patients. Objective. To substantiate surgical tactics in patients with residual post-tuberculosis lung changes. Materials and methods. The analysis of 1121 adult patients who underwent surgery from 2015 to 2021 for etiologically verified pulmonary TB and completed anti-tuberculosis therapy more than a year before the operation. Of these, 176 patients were divided into two comparable groups: the main group included 37 patients in whom non-tuberculosis mycobacteria (NTMB) DNA was found in the surgical material, the comparison group included 139 patients in whom NTMB was not found in the surgical material. All patients underwent a comprehensive microbiological and morphological examination of the surgical material. Results. In the comparison group, in the majority of operated patients with microbiological screening of surgical material, the etiological diagnosis was positive: the most informative method for both destructive forms of pulmonary TB and forms without destruction was the real-time PCR method: in 82.0% and 87.2% of positive results, respectively, and luminescent microscopy, which allowed to identify acid-resistant Mycobacteria in 67.2% of cases with destructive forms of TB and in 73.1% – without lung destruction In the comparison group, in 19 (13.2%) patients, no evidence of TB was obtained by any screening method, but morphologic examination of surgical material showed the presence of TB inflammation with high activity in 11 (58.0%) and moderate activity in 8 (42.0%) patients. In the main group species identification of NTMB in the surgical material was obtained in the majority of cases, both in forms without destruction of lung tissue and in destructive forms – in 72.2 and 63.3% of patients, respectively, slow-growing NTMB prevailing. Fast-growing NTMB were detected in isolated cases. Morphological examination of the surgical material in a group of patients with NTMB revealed structural changes in the lungs that affected the air parenchyma and/or small airways in areas of the lungs free from TB foci, which should be taken into account when planning surgical intervention. Conclusion. Surgical treatment immediately after completion of the course of anti-tuberculosis therapy in case of formation of residual post-tuberculosis changes is the method of choice in the complex treatment of this category of patients.