Immediate results of pneumonectomy in the complex treatment of patients with destructive pulmonary tuberculosis

Abstract

Introduction. Currently, surgical methods in the compre-hensive treatment of patients with pulmonary tuberculosis remain in demand all over the world. Among them, pneu-monectomy is performed in 10.3–21.8% of cases and is of-ten accompanied by various postoperative complications.Objective. Study of the immediate results of pneu-monectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis.Material and methods. A continuous retrospective study was carried out in 2012 through 2017. Inclusion criteria: pa-tients between 18 and 75 years; diagnosis verified by cul-ture technique; total destructive lesion of one of the lungs; chemotherapy for at least 6 months, taking into account the data on MTB drug sensitivity. Exclusion criteria: pre-sence of a destructive lesion in the contralateral lung. 129 patients were enrolled into the study. Patients’ sex, age, duration of the disease, complications of pulmonary tuber-culosis before surgery, MTB drug sensitivity, bacterial shed-ding, X-ray changes, respiratory function, lung perfusion, comorbidity and degree of activity of a specific process were studied, as well as the characteristics of surgical inter-ventions, intraoperative and postoperative complications. Postoperative complications were assessed in accordance with TM&M classification. Differences between groups were determined using the χ2 test. A p value less than 0.05 was considered to be statistically significant.Results. Complications in the early postoperative period developed in 52 (40.4%) patients; 26 (20.2%) patients had minor complications, 26 (20.2%) major ones. In postope-rative period 1 (0.8%) patient died. Postoperative compli-cations were eliminated in 125 (96.9%) patients. Among bacillary patients, bacterial shredding ceased in 80 (91%). Satisfactory immediate result was achieved in 120 (93%) patients, unsatisfactory, in 9 (7%). In the group of patients with major postoperative complications there were sig-nificantly more patients with a disease duration of more than 36 months, as well as those with HCV infection and MDR/XDR MTB (p<0.05).Conclusion. Pneumonectomy is a highly effective opera-tion in the comprehensive treatment of patients with uni-lateral destructive pulmonary tuberculosis