Khmel O. Surgical treatment of patients with destructive forms of chemoresistant pulmonary tuberculosis and it s complications

It has been established that the clinical and radiological data that characterize a tuberculosis lesion were confirmed by the results of morphological studies of resected preparations. The optimal term for the operative treatment of patients with MDR-TB is a period of 7-12 months from the start of anti-mycobacterial therapy. Performing traditional resections of the lungs, taking into account improved preoperative preparation increased the number of satisfactory surgical treatment results from 68.9 % to 91.2 %. The use of collapsotherapy has achieved satisfactory results in 85.7 % of patients, cure was achieved in 67.9 % of patients. A technology for the use of biological tissue welding in the surgical treatment has been developed for patients with pulmonary tuberculosis. The use of it has allowed us to avoid postoperative pulmonary and pleural complications in 98.2 % of operated patients and reduce course of the postoperative stages. A method for dissecting soft tissues of performing thoracotomy has been developed, the use of which has allowed us to shorten the duration the stage of operative access and reduce the number of postoperative complications. A method for closing the fistula of the stump of the main bronchus after pneumonectomy has been developed prevents the need for repeated surgical intervention, and reduces the length of hospital stage by 42.5 %. An algorithm for providing surgical care for patients with multidrug-resistant pulmonary tuberculosis was developed, the implementation of which ensured a cure rate of 97.5 % of patients. The overall clinical efficacy in the long-term postoperative period in patients operated with pulmonary tuberculosis was: after sublobar resections and lobectomies - 94.3 %, simultaneous resections and thoracoplastic operations - 87.4 %, pneumonectomy - 90.0 %. In patients who underwent pneumonectomy, in 91.1 % of cases compensation was observed for respiratory function. Pulmonary hypertension was observed in 16.4 % of cases. A satisfactory functional result in the long-term period after pneumonectomy was 83.6 %.