Tereshkovych O. Surgical treatment of patients with multidrug-resistant pulmonary tuberculosis and extensively drug-resistant pulmonary tuberculosis

The goal of the thesis is the improvement of the effectiveness in surgical treatment of patients with multi-drug resistant pulmonary tuberculosis (MDR-TB) and pulmonary tuberculosis with extensively drug-resistant Mycobacterium tuberculosis (XDR-TB) by applying a differentiated approach to determining the indications and duration of surgery treatment, choosing the method of surgery and development of new methods of surgical treatment. The results of surgical treatment of 613 patients with MDR/XDR-TB were analyzed. It is proved that the optimal time frame for surgical treatment of patients with MDR/XDR-TB is a period between 4-6 months from the beginning of tuberculosis treatment (TBT) by the 4th category. The scheme of presurgical assessment and indications of different surgeries of patients with pulmonary MDR/XDR-TB have been developed. Comparative analysis of results of different types of surgeries was carried out.The research proves the expediency of the methods of chest correction (pneumoperitoneum, phreniclasia or correcting thoracoplasty) by doing lung resections of patients with MDR/XDR-TB in the scope of more than 3 segments. It is proved that XDR-TB is an unfavorable factor significantly (affecting the results of surgical treatment. The research justifies the expediency of the surgical stage of treatment, even in case of so-called "residual effects of pulmonary tuberculosis".The developed algorithm of therapeutic tactics in the surgical treatment of patients with MDR/XDR-TB and the complex of measures for presurgical assessment, operative and technical features, measures for prevention of bronchial stump fistula, prevention of p/s complications and TB relapses proved to provide better results of the surgical treatment in patients of group I compared with the control.