Taking into account the data from the World Health Organization on the insufficient level of therapeutic success in the treatment of MDR and XDR pulmonary TB, surgical treatment is necessary in regions with a high frequency of drug-resistant cases.
Background: The long history of the struggle against tuberculosis (TB) inspired us to develop a new minimally invasive technique of thoracoplasty with videothoracoscope control (VATP). The aim of this study was to determine its efficacy.Methods: We conducted a retrospective single-center study of a cohort of patients operated on between 1999 and 2017. Two hundred eight patients who were indicated for thoracoplasty with verified TB with cavities in the upper lobe/S6 were enrolled in this study. Treatment outcomes were assessed based on Laserson criteria and active TB absence verified with CT.Results: Intraoperative and postoperative complications were observed in 15 (7.2%) and 4 (2.0%) cases, respectively. There were no 30-day mortalities. VATP with curative intent succeeded in 88% of cases according to Laserson criteria and active TB absence verified with computed tomography (CT). Clinical improvement (sputum negativity, closure of caverna, and lack of reactivation for 3 years) was achieved in 81% of cases. Conclusions: Comparing the successful results of this technique in the cohort of multidrug-resistant (MDR) TB patients with the outcomes of treatment of MDR TB worldwide (77% vs. 55%, respectively), the VATP technique is shown to be efficacious and thus recommended.Clinical trial registry number: ISRCTN67743278.
ФГБУ Центральный НИИ туберкулеза РАМН, г. Москва В хирургическом отделе ЦНИИ туберкулеза 226 пациентам с распространенным деструктивным туберкулезом легких были выполнены 230 резекций объемом лобэктомия и более. В основной группе-(126 пациентов), было выполнено 130 оперативных вмешательств с использованием видеоассистированной техники (ВАТС), в группе сравнения-(100 пациентов) было выполнено 100 резекций по стандартным методикам. При использовании ВАТС техники интраоперационная кровопотеря была в 2,8 раза ниже, гемотрансфузии отсутствовали, наркотические аналгетики не применялись в 80% случаев, послеоперационных осложнений было в 2,7 раза меньше, летальность отсутствовала, а эффективность лечения оказалась выше. Ключевые слова: деструктивный туберкулез, лобэктомия, видеоассоциированная техника эффективность лечения.
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