Immediate results of pneumonectomy in the complex treatment of patients with destructive pulmonary tuberculosis

Abstract

Introduction. Currently, surgical methods in the comprehensive treatment of patients with pulmonary tuberculosis remain in demand all over the world. Among them, pneumonectomy is performed in 10.3–21.8% of cases and is often accompanied by various postoperative complications.

Objective. Study of the immediate results of pneumonectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis.

Material and methods. A continuous retrospective study was carried out in 2012 through 2017. Inclusion criteria: patients between 18 and 75 years; diagnosis verified by culture technique; total destructive lesion of one of the lungs; chemotherapy for at least 6 months, taking into account the data on MTB drug sensitivity. Exclusion criteria: presence of a destructive lesion in the contralateral lung. 129 patients were enrolled into the study. Patients’ sex, age, duration of the disease, complications of pulmonary tuberculosis before surgery, MTB drug sensitivity, bacterial shedding, X-ray changes, respiratory function, lung perfusion, comorbidity and degree of activity of a specific process were studied, as well as the characteristics of surgical interventions, intraoperative and postoperative complications. Postoperative complications were assessed in accordance with TM&M classification. Differences between groups were determined using the ?2 test. A p value less than 0.05 was considered to be statistically significant.

Results. Complications in the early postoperative period developed in 52 (40.4%) patients; 26 (20.2%) patients had minor complications, 26 (20.2%) major ones. In postoperative period 1 (0.8%) patient died. Postoperative complications were eliminated in 125 (96.9%) patients. Among bacillary patients, bacterial shredding ceased in 80 (91%). Satisfactory immediate result was achieved in 120 (93%) patients, unsatisfactory, in 9 (7%). In the group of patients with major postoperative complications there were significantly more patients with a disease duration of more than 36 months, as well as those with HCV infection and MDR/XDR MTB (p<0.05).

Conclusion. Pneumonectomy is a highly effective operation in the comprehensive treatment of patients with unilateral destructive pulmonary tuberculosis.