This journal is
indexed in Scopus
Year 2019 Vol. 27 No 2
GENERAL & SPECIAL SURGERY
I.D. DUZHYI, O.V. KRAVETS, S.V. POPOV, I.A. HNATENKO
OPTIMIZATION OF SURGICAL TREATMENT OF MULTI-DRUG-RESISTANT TUBERCULOSIS OF THE LUNGS
Sumy State University, Medical institute, Sumy,
Objective. To improve treatment effectiveness in patients with multi-drug-resistant pulmonary tuberculosis, the spread of the lesion in which exceeds 5 segments, by introducing an improved combined method of treatment into practice.
Methods. The proposed method of surgical treatment was used in 17 patients with the extensive multi-drug-resistant pulmonary tuberculosis. Extended resistance was found in 6 (35.3%) people, multi-drug resistance in 11 (64.7%). The first stage of the proposed technique was the application of the pneumoperitoneum 2 months before the operation. A modified thoracoplasty was used during the surgical intervention. The operation implied a complete removal of the I rib, the partial cutting of the paravertebral segments II and IV (46 cm), V and VII (68 cm) ribs and fragmentation of the III and VI ribs by snacking them in the vertebral and axillary divisions, after which the vertebral portions II and IV, V and VII ribs «were taken together» over the fragmented sections of III and VI ribs, which significantly reduced the volume of the pleural cavity and decreased the collapse of the affected lung.
Results. The postoperative bed-day was 75.838.3. Closure of the decay cavities in the lung of the operated hemithorax had occurred in 15 (88.2%) patients by the time of discharge from the hospital. Bacterial excretion finished in 15 (88.2%) operated in the hospital. In 2 (11.8%) of the operated, bacterial excretion decreased, but the decay cavity continued to be determined. The closure of the decay cavity in one of them was recorded in 3 months after the operation at the outpatient stage of treatment.
Conclusions. The proposed method of treatment allows achieving the closure of destructive cavities, resorption of infiltrative changes in the operated lung and abacillation of patients. The method is recommended for use in the treatment of various forms of multi-drug-resistant tuberculosis, which affects more than 5 segments of the lung when contraindications to resection methods of treatment are present.
- Global tuberculosis report 2016. Geneva: WHO; 2016. 201 p. http://apps.who.int/medicinedocs/documents/s23098en/s23098en.pdf
- Cegielski JP, Kurbatova E, van der Walt M, Brand J, Ershova J, Tupasi T, Caoili JC, Dalton T, Contreras C, Yagui M, Bayona J, Kvasnovsky C, Leimane V, Kuksa L, Chen MP, Via LE, Hwang SH, Wolfgang M, Volchenkov GV, Somova T, Smith SE, Akksilp S, Wattanaamornkiet W, Kim HJ, Kim CK, Kazennyy BY, Khorosheva T, Kliiman K, Viiklepp P, Jou R, Huang AS, Vasilyeva IA, Demikhova OV; Global PETTS Investigators, Lancaster J, Odendaal R, Diem L, Perez TC, Gler T, Tan K, Bonilla C, Jave O, Asencios L, Yale G, Suarez C, Walker AT, Norvaisha I, Skenders G, Sture I, Riekstina V, Cirule A, Sigman E, Cho SN, Cai Y, Eum S, Lee J, Park S, Jeon D, Shamputa IC, Metchock B, Kuznetsova T, Akksilp R, Sitti W, Inyapong J, Kiryanova EV, Degtyareva I, Nemtsova ES, Levina K, Danilovits M, Kummik T, Lei YC, Huang WL, Erokhin VV, Chernousova LN, Andreevskaya SN, Larionova EE, Smirnova TG. Multidrug-resistant tuberculosis treatment outcomes in relation to treatment and initial versus acquired second-line drug resistance. Clin Infect Dis. 2016 Feb 15;62(4):418-30. doi: 10.1093/cid/civ910
- Ojiezeh T, Ogundipe OO, Adefosoye VA. A retrospective study on incidence of pulmonary tuberculosis and human immunodeficiency virus co-infection among patients attending National Tuberculosis and Leprosy Control Programme, Owo centre. The Pan African Medical Journal. 2015;20:345. doi: 10.11604/pamj.2015.20.345.5643
- Todoriko LD, Volf SB, Kuzhko MM, Gelberg IS, Alekso EN, Semianiv IA. Contemporary aspects of tuberculosis problems analyzing the situation in some regions of Ukraine and Belarus. Zhurn GrGMU. 2016;(2):75-78. http://journal-grsmu.by/index.php/ojs/article/view/1940 (in Russ.)
- Batyrrshina YaR, Krasnov VA, Petrenko TV. Treatment outcomes of multiple and extensive drug resistant tuberculosis and efficiency of surgical resections in patients with high risk. Tuberkulez i Bolezni Legkikh. 2016;94(5):28-34. doi: 10.21292/2075-1230-2016-94-5-28-34
- Prasad R, Singh A, Balasubramanian V, Gupta N. Extensively drug-resistant tuberculosis in India: Current evidence on diagnosis & management. Indian J Med Res. 2017 Mar;145(3):271-93. doi: 10.4103/ijmr.IJMR_177_16
- Naidoo P, Theron G, Rangaka MX, Chihota VN, Vaughan L, Brey ZO, Pillay Y. The South African Tuberculosis Care Cascade: Estimated Losses and Methodological Challenges. J Infect Dis. 2017 Nov 6;216(Suppl_7):S702-S713. doi: 10.1093/infdis/jix335
- Laptev AN, Karatysh MI. Otdalennye rezul’taty rannego primeneniia ekstraplevral’noi torakoplastiki v kompleksnom lechenii bol’nykh infil’trativnym, tuberkulezom legkikh s mnozhestvennoi lekarstvennoi ustoichivost’iu. Med Panorama. 2010;(9):14-16. https://www.bsmu.by/files/8b24f33d7e933cc948fd87d0b2c53425 (in Russ.)
- Laniado-Laborín R. Multidrug-resistant tuberculosis: standardized or individualized treatment? The question has already been answered. Expert Rev Respir Med. 2010 Apr;4(2):143-46. doi: 10.1586/ers.10.6
- The role of surgery in the treatment of pulmonary TB and multidrug- and extensively drug-resistant TB. WHO Regional Office for Europe; 2014. 17 ð. http://www.euro.who.int/__data/assets/pdf_file/0005/259691
- Yerimbetov KD, Zetov AS, Abildayev T, Bekembayeva GS, Ismailov SS. The effectiveness of surgical methods of treatment of pulmonary tuberculosis for patients with multidrug resistant at adequate chemotherapy (retrospective, case control, comparative research). Surg Sci. 2014;5(4):164-69. doi: 10.4236/ss.2014.54029
- Giller DB, Shaikhayev AYa, Tokayev KV, Yenilenis II, Martel II, Glotov AA, Papkov AV, Sadovnikova SS, Asanov BM, Giller GV, Volynkin AV, Barilo VN. Immediate results of surgical treatment in destructive pulmonary tuberculosis patients excreting extreme drug-resistant MBT. Tuberkulez i Bolezni Legkikh. 2010;(3):18-22. (in Russ.)
- Dheeraj S, Anula S, Sanjeev D, Rajendra MM. Thoracoplasty: a 15 year single centre experience. IOSR-JDMS. 2017;16(03):124-27 doi: 10.9790/0853-160306124127
- Krasnov D, Krasnov V, Skvortsov D, Felker I. Thoracoplasty for Tuberculosis in the Twenty-first Century. Thorac Surg Clin. 2017 May;27(2):99-11. doi: 10.1016/j.thorsurg.2017.01.003
- Omel’chuk DE, Tychkova IB. Effektivnost’ kollapsokhirurgicheskikh i kombinirovannykh vmeshatel’stv pri rasprostranennom fibrozno-kavernoznom tuberkuleze legkikh. Tuberkulez i Bolezni Legkikh. 2011;88(5):86. https://elibrary.ru/item.asp?id=16453283 (in Russ.)
Sumy, Troitskaya Str., 48,
Sumy State University,
Department of General Surgery,
Radiation Medicine and Phthisiology.
Tel. 8 (0542) 65-65-55,
Igor D. Duzhyi
Duzhyi Igor D., MD, Professor, Head of the Department of General Surgery, Radiation Medicine and Phthisiology, Medical Institute, Sumy State University, Sumy, Ukraine.
Êravets Oleksandr V., PhD, Associate Professor of the Department of General Surgery, Radiation Medicine and Phthisiology, Medical Institute, Sumy State University, Sumy, Ukraine.
Popov Sergey V., MD, Professor of the Pediatrics Department, Medical Institute, Sumy State University, Sumy, Ukraine.
Hnatenko Ivan A., Post-Graduate Student of the Department of General Surgery, Radiation Medicine and Phthisiology, Medical Institute, Sumy State University, Sumy, Ukraine.