Substantiation of indications and optimal time for carrying out low-invasive surgical interventions in treatment of patients with tuberculosis of lungs and pleura

Abstract

Objective — to study and justify the indications and the optimal timing for minimally invasive surgical interventions in the treatment of patients with pulmonary tuberculosis (TB) and pleura.Materials and methods. A retrospective analysis was performed among patients and the clinical group. We analyzed 169 VATS surgical interventions in patients with pulmonary TB. All patients were examined and treated at the Department of Thoracic Surgery and Invasive Diagnostics of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky AMS of Ukraine» in the period from 2008 to 2018. The medical records of Department was studied and analyzed, as well as extracts of medical records from other hospitals.Results and discussion. The main indications for VATS interventions in patients with pulmonary tuberculosis are the so-called «small forms of tuberculosis», namely: tuberculoma 72 (55.4 %) cases, conglomerate tuberculoma 11 (8.5 %) cases, multiple tuberculomas 8 (6.2 %) patients and caseoma in 4 (3.1 %) patients. Surgical interventions (and VATS resections in particular) must be carried out in the phase of remission and compensation of the tuberculosis process. The optimal timing for VATS-resection of the lung in patients with pulmonary TB is 2 months from the beginning of TB treatment in category I (in the presence of sensitive TB) and 4—6 months from the beginning of a full-fledged TB treatment for category IV (in the presence of chemoresistant TB). That is, patients 2—4—6 months. treatment should be examined by thoracic surgeons for the necessity and possibility of surgical treatment. This is especially true for patients with no effect of conservative TB treatment for 4 months or more (the presence of constant or persistent bacterial excretion, the absence of positive radiological and/or microbiological dynamics).Delaying the patient’s direction to surgical treatment leads to a deterioration in the results of surgical treatment, an increase in the volume of resection interventions, more frequent palliative colapsosurgical interventions. The main indication for VATS plelectomy with pulmonary decortation is chronic tubercu­lous pleurisy of 1 st with a disease duration of up to 2 months.Conclusions. There are no clear terms for VATS interventions in patients. Surgical interventions are preferably carried out in the phase of remission and compensation of the tuberculosis process. According to urgent indications (pulmonary bleeding, intense pneumothorax, etc.), the acute phase of the tuberculosis process should not be an obstacle to the surgical elimination of symptoms that threaten the patient’s life. In special cases, with the steady progression of tuberculosis, which is localized within no more than one lung, you can resort to an extended resection or pulmonectomy. In these cases, intensive antimycobacterial therapy and correction of homeostasis are necessary.