Effectiveness of partial lung resection at multi-drug resistance of tuberculosis mycobacteria
Abstract
Partial resection of lung at multiple drug resistance of mycobacteria was performed in 59 patients (males -36, females - 23) in ages 17 – 54 years. All the patients had fibrous-cavernous tuberculosis with long clinical course (over 3 years) and resistance of mycobacteria to izoniazid + rifampicin in 4 patients, to izoniazid + rifampicin + streptomycin – in 24, to izoniazid + rifampicin + streptomycin + ethambuthol – in 31. The characteristic peculiarities of illness were dissemination (61.0%) and progress (45.8%) of the tubercular process, pulmonary hemorrhage (27.1%), various sonsomitant pathology (32.2%), and ineffectiveness ofpreceding long treatment. After pre-operative chemotherapy (pirazinamid + amicacin + ofloxacin + protionamide + paraaminosalicylic acid + cycloceril) with pneumoperitoneum, UV irradiation of blood, transfusion of protein, saline and synthetic solutions, a segmental lung resection was performed in 9 patients, lobectomy – in 38, combined resection – in 12. After operations, bronchial fistula and pleural empyema developed in 4 patients, early re-activation of tuberculosis – in 3. These complications were eliminated in 6 patients. Good effectiveness of partial lung resection was reached in 58 patients (98.3%). One patient (1.7%) died from the progress of post-operative pleural empyema and cardio-pulmonary insufficiency. Conclusion. Partial resections at fibrous-cavernous tuberculosis with multiple drug resistance of mycobacteria is a highly effective method of treatment and it heals 98.3% of patients with chronic pulmonary pathology.