Comparison of the effectiveness of conservative and surgical methods for treatment of patients with multidrug-resistant tuberculosis

Abstract

Objective — referring to literature data on the effectiveness of antibacterial therapy in multidrug-resistant tuberculosis (MDR TB) of lungs, to develop an algorithm for treating patients with such forms of tubercu-losis. It based on comparing the effectiveness of conservative antibiotic therapy and surgical treatment according to the methods, developed by the authors on the background of double collapse of the lungs.Materials and methods. Under the supervision of the authors during 2011—2017 there were two groups of patients. The comparison group included 1136 patients with multidrug resistant pulmonary tuberculosis treated only with antimycobacterial drugs. The main group consisted of 107 patients with multidrug resistant pulmonary tuberculosis, who were operated on according to the methods developed in the TB clinic of Sumy State University. The proposed technique is based on the double collapse of the operated lung. Observation in the remote period was conducted during 7 years.Results and discussion. The treatment of patients in the main group was more frequent than the comparison groups in 2.2 times. Among patients in the comparison group during the observation period, 20 % of patients died, in the main group — 3.7 %, which is less 5.4 times (p < 0.05); unsuccessful treatment with interrupted in the comparison group was fixed at 32.7 %, in the main group — 7.5 %, which is less 4.4 times (p < 0.05).Conclusions. Double collapse of the lungs is a reliable alternative to antibiotic therapy in the proposed methods of surgical treatment of MDR TB. Surgical treatment of patients with limited prevalence of MRI can be applied by the type of resection, and in common processes — by the type of extrapleural thoraco-plasty.Surgery for multidrug-resistant pulmonary tuberculosis, according to the proposed algorithm, contributes to a positive effect (negative smear conversion, closure of decay cavities), which exceeds that in conservative treatment by 1.9 times. The unsuccessful effect at conservative therapy occurs more often than at surgical intervention in 3.5 times, and dies of such patients more in 5.4 times.