The purpose of the study was to improve quality of surgical treatable of destructive pulmonary tuberculosis in patients with diabetes.Materials and methods. D.B. Giller and employees of the Department of Phthisiopulmonology and Thoracic Surgery of the First Moscow State Medical University M.I. Sechenov performed operations on 200 patients with diabetes due to tuberculosis. Group 1 was mustered from 78 patients from 2004 to 2009. Group 2 was mustered from 122 patients from 2011 to 2017.Results. An analysis of the results showed that after 31 operations, 27 (13.5%) patients from both groups developed 33 complications. The second group (6,6 %) had fewer complications after surgery than the first group (24,4%) 3.7 times. The first group had more vulnerary and bronchopleural complications than the second group. 12 patients (15,4%) of the first group and 6 patients (4,9%) of the second group had bronchopleural complications (empyema, residual cavity, delayed expansion of the lung and intrapleural bleeding). 2 patients died in the hospital (30-day mortality was 0.66%) after 303 surgical intervention in both groups. 1 patient (0.9%) died after 106 surgical intervention in the first group. 1 patient (0.5%) died after 197 surgical intervention in the second group. The full effect was achieved in 75 (96.2%) patients in the first group and 114 (93.4%) in the second group. The survival value of patients of the second group was 100% after 1 year, 98% after 2 years, 98.8% after 3 years, 96.9% after 4 years, 95.2% after 5 years. The surgical treatable affected the occupational rehabilitation of patients from group 2. 61.5% of patients from group 2 became able to work after 1 year. 64.5% of patients from group 2 became able to work after 5 years.Conclusion. If doctors will use our tactics in patients with destructive pulmonary tuberculosis and diabetes, the risk of complications after surgery dropped and reactivation of tuberculosis will not occur.
THE OBJECTIVE of our study was to increase the efficiency of treatment of tuberculosis postoperative reactivations in a previously operated lung, by clarifying the medical indications, improving surgical techniques and tactics when removing a previously resected lung.METHODS AND MATERIALS. We analyzed the results of treatment of 220 patients who, in the 2004–2017 timeframe in our institution, had pneumonectomies (76 cases) and pleuropneumonectomies (144 cases) for tuberculosis relapse in a previously operated lung. For more objective planning of surgical treatment and evaluation of its results, we identified three degrees of treatment radicalism: radical, conditionally radical, and palliative.RESULTS. 32 patients, who had carried a radical surgery, were diagnosed as having a complete clinical effect at the time of discharge (absence of destruction cavities in a single lung, bacterial excretion and illiquid complications) in 100 % of cases; in the group of patients operated conditionally radical, there were diagnosed 161 out of 168 (95.8 %) and in the group of patients operated palliative, there were distinguished only 3 cases out of 20 (15.0 %).CONCLUSION. The implementation of the completion pneumonectomy and pleurapneumonectomy is accompanied by high technical complexity and more frequent development of intraoperative and postoperative complications. At the same time, the high efficiency of treatment of tuberculosis relapses in a previously operated lung can be achieved using the recommended tactics and techniques of surgical treatment when performing radical and conditionally radical interventions.
Цель исследования: повышение эффективности хирургического лечения бронхоплевральных осложнений после пневмонэктомий у больных туберкулезом (ТБ) за счет разработки современных показаний, тактики, техники лечения и методики послеоперационного ведения. Материалы и методы. Проанализированы истории болезней 114 пациентов, которым были выполнены различные варианты хирургических вмешательств по поводу бронхоплевральных осложнений после пневмонэктомий в период с 2004 по 2010 гг. на базе Центрального НИИ туберкулеза РАМН и в период с 2011 по 2017 гг. в клинике фтизиопульмонологии Первого МГМУ им. И.М. Сеченова. Для более объективной оценки результатов исследования в зависимости от наличия или отсутствия бронхиального свища пациенты были разделены на две группы: I группа - пациенты с эмпиемой и бронхиальным свищем, II группа - пациенты с эмпиемой без бронхиального свища. Результаты. В I группе в результате хирургического лечения добиться ликвидации эмпиемы и бронхиального свища удалось в 57 (86,4%) случаях, у пациентов II группы постпневмонэктомическая эмпиема была излечена во всех случаях. Госпитальная летальность в I группе составила 9% (6 случаев), во II группе случаев госпитальной летальности не было. Таким образом, общая эффективность лечения бронхоплевральных осложнений составила 92,1%. Заключение. Развитие бронхоплевральных осложнений после пневмонэктомий является тяжелой клинической ситуацией, требующей сложных, часто многоэтапных хирургических вмешательств. Однако с применением рекомендованной тактики и техники хирургического лечения возможно достижение высокой эффективности при низких показателях рецидивов и летальности.
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