Abstract
Congenital malformations of the bronchopulmonary system in combination with tuberculosis are extremely rare in practice, but they usually require surgical treatment. This combination often causes diagnostic difficulties.Characteristics of children and research methods. We have analyzed the experience of surgical treatment of a combination of various congenital lung defects and tuberculosis in 20 children. 9 (45%) children had lung sequestration, 4 (20%) children had lung hypoplasia, 5 (25%) children had congenital bronchiectasis, 1 (5%) child had arteriovenous malformation, and 1 (5%) child had a congenital lung cyst. There were 3 segmental resections, 15 lobeand bilobectomies, and 3 pneumonectomies. All surgeries were performed using minimally invasive approaches (VATS).Results. 11 (55%) patients had diagnostic difficulties of concomitant pathology. Only in 5 (25%) cases they found mycobacteria in sputum before surgery. Postoperative study of material from tuberculous lesions helped to establish multidrug resistance of mycobacterium tuberculosis and to change the chemotherapy regimen in 3 (15%) patients. There were no postoperative complications or deaths. All surgeries were effective. Long-term results were studied in 16 (80%) of 20 patients over a period from 1 to 10 years. No cases of reactivation of tuberculosis or disability.Conclusion. Resection surgery for combination of tuberculosis and congenital lung defects allowed to clarify the diagnosis and to achieve a direct effect in all patients by clarifying the drug resistance of mycobacterium tuberculosis and to optimize postoperative chemotherapy.
Highlights
Врожденные пороки развития бронхолегочной системы у детей в сочетании с туберкулезом в практике встречаются крайне редко, но, как правило, требуют хирургического лечения
Congenital malformations of the bronchopulmonary system in combination with tuberculosis are extremely rare in practice, but they usually require surgical treatment
We have analyzed the experience of surgical treatment of a combination of various congenital lung defects and tuberculosis in 20 children. 9 (45%) children had lung sequestration, 4 (20%) children had lung hypoplasia, 5 (25%) children had congenital bronchiectasis, 1 (5%) child had arteriovenous malformation, and 1 (5%) child had a congenital lung cyst
Summary
В практике детских торакальных хирургов чаще всего встречаются секвестрация легкого, гипоплазия легкого и врожденные бронхоэктазы [1, 2, 4, 7, 13, 15,16,17]. Очень редко секвестрация легкого может сочетаться с туберкулезом легких или лимфатических узлов, что усложняет диагностику и хирургическое лечение. (2015) [9] привели данные успешного хирургического лечения секвестрации и туберкулеза легкого у двух взрослых пациентов. К частым порокам развития легкого относится поликистоз легкого или кистозная гипоплазия. На долю поликистоза приходится 60–80% всех пороков развития легких, при этом он характеризуется неуклонным ростом заболеваемости среди детей, учащением обширных, запущенных и тяжелых форм поражения [13, 22]. Однако информации о сочетании гипоплазии легкого с туберкулезом внутригрудных лимфатических узлов нами в литературе не найдено. В работе мы обобщили свой опыт хирургического лечения такой редкой патологии, как сочетание врожденных пороков развития легких с туберкулезом у детей
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