Abstract
In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done. In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention. Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start. According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients. Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment.
Highlights
In the treatment of pulmonary tuberculosis, which is accompanied by irreversible morphological changes in the pulmonary tissue [1, 2], surgical methods are a priority [3]
According to the available data [10], despite significant drugs and various methods of chemotherapy, treatment of multiple/polysaccharide destructive tuberculosis is unsatisfactory: after more than 3 months of therapy, the smear conversion was observed in only a quarter of patients, with only 14.3 % of them it corresponded to the improvement of clinical and radiological data [11, 12]
The study included all 176 multidrug-resistant pulmonary tuberculosis (MDR-PTB) patients and those with advanced resistant tuberculosis (ARTB) that was registered in the specified areas during 2013–2014
Summary
In the treatment of pulmonary tuberculosis, which is accompanied by irreversible morphological changes in the pulmonary tissue [1, 2], surgical methods are a priority [3]. According to the available data [10], despite significant drugs and various methods of chemotherapy, treatment of multiple/polysaccharide destructive tuberculosis is unsatisfactory: after more than 3 months of therapy, the smear conversion was observed in only a quarter of patients, with only 14.3 % of them it corresponded to the improvement of clinical and radiological data [11, 12]. At present, the main challenge in global control of tuberculosis in connection with the small selection of treatment methods [13, 14]. A combined therapeutic and surgical approach is increasingly used to treat these patients [15, 16]
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